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We've joined the American Migraine Foundation to fight debilitating head pain together.
As part of our ongoing commitment to providing meaningful information, resources and support for those living with headache diseases, Clusterbusters is thrilled to announce our new partnership with the American Migraine Foundation.
The American Migraine Foundation is the official resource for millions of Americans living with migraine disease and other head pain diseases seeking reliable information about diagnosis, treatment and advancements in research. Launched in 2010 as a patient support and advocacy effort of the American Headache Society, AMF's mission is to mobilize a community for people living with migraine and their support networks and to drive impactful research into the third most common and sixth most disabling disease around the globe.
"Clusterbusters is a cornerstone organization in the cluster headache world. It is truly an honor to work alongside them to elevate our voices for increased research, support, and advocacy for the cluster community," says American Migraine Foundation Executive Director Meghan Buzby. "We look forward to making a stronger impact together."
Like Clusterbusters, the American Migraine Foundation is dedicated to helping people with headache disease live meaningful and pain-free lives. We're so excited to join forces with AMF to provide support, advocacy and treatment innovations to people living with these disabling diseases.
The American Migraine Foundation supports people living with migraine and other head pain diseases by:
We couldn't be more excited about this collaboration. Be on the lookout for additional resources and enhanced communication from our team in the very near future.
The American Headache Society (AHS) Symposium took place last month in Phoenix at the JW Marriott Desert Ridge Resort and Spa. Several of our Clusterbusters board members and President, Bob Wold, were in attendance along with one of our favorite neurologists, Dr. Brian McGeeney. There are several things we learned over the course of the four-day conference. The first notable impression we gained was the absence of Cluster Headache in both the syllabus and the minds of the physicians.
AHS did a wonderful job educating medical professionals on all aspects of Migraine including diagnosis, prevention, treatment, and emerging options for patients. The less common headache disorders, both primary and secondary, were mentioned, but the main focus of the symposium was Migraine, which makes our attendance more essential than ever.
We learned and accomplished many things that will hopefully help the cluster headache community, which include:
The CGRP (Calcitonin Gene-Related Peptide) antibody studies by Teva Pharmaceutical Industries and Eli Lily & Co. are perhaps the most promising trials for cluster headache patients right now—Aside from Dr. Schindler's study on psilocybin at Yale University. CGRP is a natural-occurring protein in the body that is believed to attach to brain receptors and activate sensory neurons in your trigeminal nerve, which instigates the severe pain of a cluster headache attack.
The theory behind this emerging treatment is to inhibit or reduce the amount of CGRP released in the brain. The early Friday morning presentation involved a 3D representation of how the CGRP is released and attaches to neurons. There are four ongoing trials, two of which include cluster headaches, and three of which could be FDA-approved in 2018.
The clinical trials happening in many U.S. regions involve a monthly (typically three months but patients can opt to continue treatment) subcutaneous injection for the Eli Lily study or both a subcutaneous injection and IV infusion for the Teva study. They're still actively looking for more cluster headache patients to participate. If you're interested, you'll need to complete several steps, such as:
Both episodic and chronic patients can participate, but the episodic process is slightly different. Learn more at https://clinicaltrials.gov/ct2/show/NCT02466334.
Most medications used to treat cluster headaches can be continued until conception but must be stopped during pregnancy. Some women are pain-free while others experience an increase in attacks or the start of an episodic cycle while pregnant. Aborting attacks with high-flow oxygen is one option, but sumatriptan, DHE, Topamax, prednisone, and other popular medications used for cluster headaches have to be discontinued to avoid birth defects, premature births, and miscarriages.
Luckily, there are some safe options available for women struggling with attacks during pregnancy. We learned during the AHS Symposium that the newly FDA-approved, non-invasive Vagus Nerve Stimulator (VNS) by gammaCore® and occipital nerve stimulation (ONS) could be used safely during pregnancy to treat attacks. The VNS is a handheld device (seen on the left) approved for episodic and chronic cluster headaches that can abort an attack in approximately 15 minutes. Studies show that both the VNS and ONS result in less acute medication use and less medication overuse.
We already know cluster headaches have a profound impact on our mental health such as the development of PTSD and depression. One of the presentations talked about the potential link between Borderline Personality Disorder (BPD) and head pain. There's a cognitive-behavioral model of panic disorder that makes one wonder which came first. Many of us have been there—You experience a stressor that you associate with a cluster headache attack, fear of the attack develops, you take medication to "prevent" said attack when there may not have been one coming.
A 2009 study focused on the psychiatric link in patients with chronic daily headache and migraine. However, in theory, cluster headaches can be looped in with the results. They found that individuals with Migraine are 2.2-4 times more likely to suffer from depression and may have an increased suicide risk. Medications can help the mental health aspect, but it's difficult to treat both head pain and depression effectively. Given that cluster headaches are nicknamed "Suicide Headaches" because the rate of suicide attempts is 20 times the national average, this makes perfect sense to us. A 2012 study on depression and anxiety in cluster headache patients found this link was especially powerful.
A Friday afternoon speech at the AHS Symposium focused on pediatric patients with migraines, and it was difficult to get one of the speakers even to admit that children also get cluster headaches (Thanks, Dr. McGeeney!). There are so many awful side effects associated with common off-label medications used for cluster headaches including Topamax that it's hard to determine what's actually safe for kids with cluster headaches and migraines to use. Surprisingly, the recommended preventative for kids as young as six with Migraine was Topamax.
Experts agree that the average age of onset of Cluster Headache is between ages 20 and 40, but 35 percent of patients report having their first attack before the age of 20, which often results in a delayed diagnosis or misdiagnosis. We know of several children as young as eight who have cluster headaches and little to no treatment options. This is one of Clusterbusters goals right now—To develop a thorough resource for parents of young children with cluster headaches to learn more about the condition, what treatments may be viable and most importantly, safe, so the child can continue to grow and learn.
Your circadian rhythms, REM sleep, and melatonin levels play an interesting role in cluster headaches. You likely know that nighttime attacks are one of the major indicators of CH, and the worst attacks to treat because you wake up with a full-blown K10. All of this makes it hard to maintain good "sleep hygiene." A set routine is easier said than done, but it's believed that maintaining a consistent sleep schedule may help turn chronic migraines (again, no mention of Cluster Headache) into episodic. However, the opposite may happen if you don't stick to a strict sleep schedule.
During the only main-stage presentation on Trigeminal Autonomic Cephalalgias (Cluster Headache, SUNCT, and Hemicrania Continua) an audience member asked about the Vitamin D3 Regimen and proper oxygen use and was all but met with blank stares. That drove the point home for us that we need to find a way to educate medical professionals (primary physicians, specialists, emergency responders, etc.) on the correct way to approach treatment for a cluster headache patient.
The absolute first step a medical professional should take following a cluster headache diagnosis is to write a script for 12-15lpm of high-flow oxygen with a nonrebreather mask. Sadly, many physicians are under the misconception that all patients will develop oxygen toxicity at this rate, but unless there's a pre-existing lung issue, this is not a problem. We've known since the 1930s that oxygen works for cluster headaches, and it's honestly astonishing that we're still fighting our doctors and insurance companies to provide it. Essentially, our work is far from done.
Other aspects that piqued our interest involved the booths in the exhibit hall. The folks from Eli Lily & Co., electroCore, LLC, Teva, Biohaven Pharmaceuticals, Allergan, and many others lined the walls. We were met with many questions about cluster headaches and how they differ from migraines as we made our way down the circular path.
Biohaven Pharmaceuticals was particularly intriguing. Not only did they have this awesome 3D printer making headphone cases, but their product is said to work well for migraines, and maybe cluster headaches someday soon. Biohaven has developed a CGRP receptor antagonist proposal that has two main goals: acute migraine treatment and prevention of episodic and chronic migraine. Currently, it comes in pill form.
Aside from the cool booths (Eli Lily had a Lego brain approximately two feet high), we learned or were at least reminded that it's important to be skeptical. Cluster headaches are often ignored even though it's a primary headache disorder because of the low number of patients and misinformation about women with CH. Additionally, neuromodulation was discussed at length during one presentation and is considered the best mode of action when all else fails to work.
Our board members and President were fortunate enough to be invited to the special interest meeting on the Trigeminal Autonomic Cephalalgias. We met more than a dozen medical professionals and neurologists who were fascinated by Cluster Headache and eager to learn what their patients need from them. This was the most exciting part of the AHS Symposium for us. This meeting changed the way many of them view cluster headaches. We hope to continue working with this group on improving the diagnosis rate and treatment for all cluster headache patients.
2017 Conference
Presidents Report
This year's conference in Chicago was both a huge success and an exercise in adjustments on the run for all the volunteers and especially conference coordinator Eileen Brewer.
We had a sell-out crowd with over 200 attendees from 6 different countries. With the standing room only crowd, we had to make some adjustments on side sessions and increasing the size of the main meeting room.
The President's reception on Thursday night went very well. The increased attendance was handled well by all the volunteers running registration. There were many 1st timers arriving and everyone tried their best to welcome them and make them feel at home. The main purpose of the reception is to give people a chance to meet new friends and rekindle old friendships. I want to thank everyone that was trying to greet the newcomers. The reception allows people to settle in, meet people and register before the conference presentations begin.
Remarks to follow on portions of the schedule as the weekend proceeded.
September 15, 2017
Opening Remarks
Eileen Brewer opened the conference with an inspiring presentation that would set the tone for the conference. Thank you Eileen for your opening remarks. Well done.
Introductions with Ainslie Course
Standing in for Dan Irvin, who could not make the trip this year due to illness, Ainslie Course did a wonderful job facilitating one of the most important parts of our program. Everyone in the room had a chance to introduce themselves and to give a little background information. People may discover neighbors they didn't know they had or find an instant cluster connection with someone living 4000 miles away. This is an important part of welcoming everyone into the family. Well done Ainslie.
Throughout the rest of the conference, Ainslie did a wonderful job as MC and kept us on time and with a very good flow for the program. This is not an easy task and Ainslie did a remarkable job.
Presentation: Bringing You Up to Date
Bob Wold
As we had such a full schedule this year, there wasn't a lot of time available to detail a lot of what has been happening this year. I can now give more details on some of the items I was able to highlight during the conference.
This year, 2017 marked 15 years since Clusterbusters was formed to advance research and became the year that we finally reached our goal of our original mission and that Clusterbusters was founded upon. Our research that began at Harvard has finally admitted the first cluster patient in an FDA approved clinical study looking at treating clusters with psilocybin. It took 15 years of dedication by a lot of people but we finally reached our initial goal.
An ironic part of the story is that we had always been told that the government would never let us do this study and they would block us at every turn. It turns out that the study is being done at a Veterans Administration research hospital. This is what happens when you won't take no for an answer. Not only are they allowing us to conduct the study, they are supplying the facility. This study, in partnership with Yale University and with the help of additional funding, is history making. With Dr. Emmanuelle Schindler as the principle investigator, the first person in history was given FDA approved and legally permissible psilocybin to treat cluster headaches in the USA. Truly, patient number 1.
Additional updates follow.
We had 11 sponsors this year, our biggest contingent yet, and their contributions were many and very much appreciated. Not only were they all there to help educate the community on different treatments and treatment facilities, they were also there to let everyone know of all the opportunities available for working on advocacy, research and education. It was impressive to see so many people working for our community.
The sponsors financial contributions all go toward making the conference the special experience that it is for everyone. We are able to keep costs as low as possible for people to attend the conference. Registration fees do not cover anywhere near the costs per person, and our sponsors allowed us to cover these additional costs and also offer travel scholarships. We were able to help more people than we've ever been able to help in previous years to attend. Without our sponsors, 20-25 people would not have been able to otherwise attend the conference.
Our conference is a unique opportunity for our community to meet these companies and organizations and teach them who we are, what we need and help them understand how cluster headaches affect the families that deal with them. Unlike most conferences of this type, Clusterbusters keeps the sponsors in the meeting space along with the attendees so they can learn about clusters and more importantly the people that make up our community. We feel it is vitally important that when our sponsors go back to work after the conference, they can put a face on the people and families they are working to help. The Clusterbusters community is not sitting back and waiting for help from others. We are a vital part of the process and involved from the beginning.
Opportunities to help our community
We had two separate areas at the conference where people could participate in genetic research for cluster headaches. Dr. Shapiro and his crew were collecting blood samples and DNA for their genetic study and many people took part. Dr. Burish was also collecting DNA data and information.
This was an exciting opportunity for people to take part in important clinical research while at the conference. Thank you to everyone that took this opportunity to move this research forward. Hopefully in the not-to-distant future, generations of people will no longer have to worry about cluster headaches. There will be a cure and it is research such as this that will produce that cure. Pieces of the puzzle were put together at our conference and each year the community fits together more of the most difficult pieces.
I was very happy to be able to announce some of our new partners that we are working with to improve and fulfil our missions of advocacy, education, awareness and research. We are building a team and making Clusterbusters and entire the cluster headache community a vital part of improving the lives of everyone suffering with headache disorders. These affiliations make our voice louder, opens up more doors and increases the size of our footprint. They broaden our reach into the medical community and help us teach the general population about cluster headaches. Our room full of cluster advocates is an impressive sight and everyone there is doing great work for the community. We are finding new ways to educate the medical community as well as other organizations that can help the cluster community. We are making sure that our community is taking an active role in all aspects of the health care system and making a difference.
The current list of our affiliations is as follow:
AHDA – Alliance for Headache Disorders Advocacy
AHMA – American Headache & Migraine Association
HMPF – The Headache and Migraine Policy Forum
AFPA – Alliance for Patient Access
CHAMP – Coalition for Headache and Migraine Patients
NORD – National Organization for Rare Diseases
HCNE – Headache Cooperative of New England
US Pain Foundation
NHF – National Headache Foundation
Migraine World Summit
Patients Rising
M4M – Miles for Migraine
AHS – American Headache Society
RPV – Rare Patient Voice
Speaker Presentations
The following list of speakers filled out two full days of presentations that covered new treatments, new research, caregiver stories, advocacy and education events. Presentations were given by the following list of doctors, advocates and experts in various fields.
Dr. Brian McGeeney
Mr. Hans-Joerg Tangermann
Mr. Bill Mingus
Ms. Ashley Hattle
Ms. Katie Golden
Dr. Robert Shapiro
Dr. Larry Schor
Dr. Alexander Feoktistov
Mrs. Erika McDermott
Mr. Dan Duhart
Dr. Mark Burish
Dr. Emmanuelle Schindler
Mr. Kevin Lenaburg
Detailed reports of the presentations will follow soon. We will also be releasing videos of many of the presentations shortly.
In addition to the presentations there were many other things going on throughout the weekend. We had two focus groups, "Safe Room" sessions for both sufferers and caregivers, 02 demonstrations, raffles and auctions, discussion and Q & A panels, scientific poster presentations, book signings and even a magician.
Beginning a few years ago, Clusterbusters started giving out special awards to people or organizations that make a major contribution in advancing our mission and improving the lives of the people in our community. It is never an easy decision making our choices for the awards as there are a lot of good people doing great work. This year's award recipients were:
Excellence in Research 2017
Dr. Mark Burish
Mark is currently assistant professor of neurosurgery at UT Houston where he performs research on cluster headache. He also treats patients with a variety of pain and headache conditions. During our conference Mark gave his presentation on a Circadian Study he is undertaking.
Mark is also running a study collecting genetic data on cluster headache patients. This will be an important step toward eventually finding genetically based treatments and a cure in the future. It is a huge step forward for everyone in our community in that we now have incredibly dedicated people working on laying the groundwork to find a cure and not just more treatments for the symptoms we experience.
Mark has become an important voice for us within the medical community specializing in headache disorders. Mark's work makes sure that cluster headaches are a constant topic of discussion during the professional conferences as well as in the research labs. Thank you Mark.
Excellence in Education 2017
Ms. Ashley Hattle
Ashley started a support group for cluster headaches in Denver in early 2016 which meets every other month. The group is supported by Clusterbusters as a regional support group. Her Denver group has grown from three members to more than 15. She organized the first ever 5K to raise awareness and funding for cluster headaches on June 17, 2017. More than 25 people ran the race and the group was able to raise several thousand dollars for research. All the money raised by Ashley through this event will be used for the psilocybin research project going on at Yale and the Veterans Administration.
Ashley's Denver group is involved in educating the public and the local Denver medical establishment regarding cluster headaches. Her fundraiser gained a great deal of print and radio airtime educating a wide audience on cluster headaches.
Ashley recently had her book on cluster headaches published and it is receiving great reviews. It is a wonderful teaching tool for patients, caregivers and the general public. Thank you Ashley.
Excellence in Awareness 2017
Ms. Shirley Kessel
Shirley is the President of Miles for Migraine, a non-profit organization that holds fundraising walks/runs in cities across the US with all funds used for research, education and advocacy work for people with headache disorders. They also host educational conferences in these cities as part of the events. They are able to generate a great deal of public awareness and publicity for their events. Miles for Migraine is very much involved in helping organize, support and fund many of the advocacy and education events in which Clusterbusters also participates. Clusterbusters has partnered with Miles for Migraine and will be working with them at their events. Every dollar raised by those people participating in these events for the benefit of cluster headaches, will go directly to Clusterbusters and will be used for our research and advocacy projects.
Working with Shirley and Miles for Migraine, Clusterbusters will be setting up informational and educational booths which greatly increases our outreach to the general public and the medical community. Thank you Shirley.
Excellence in Advocacy
Dr. William Young & The Alliance for Headache Disorders Advocacy
Dr. Young, the current President of the AHDA accepted this award on behalf of the Alliance (AHDA)
Clusterbusters has been a member of and working with the AHDA for seven years. Although the big event is Headache on the Hill which takes place once a year in Washington DC, this work continues throughout the year. One of the most important issues that the AHDA works on is trying to get Medicare and Medicaid to cover the costs of 02 treatment for cluster patients.
The AHDA has had specific legislation passed in congress that helps all people with headache disorders. They have also been able to greatly increase the levels of research funding in several government agencies. Their advocacy work also raises awareness and educates people in positions that can help us.
One of the biggest benefits of Clusterbusters working with the AHDA is the Headache on the Hill event that allows us to bring our cluster advocates together and also train new advocates. HOH is an event that empowers all that attend and allows us to tell our stories and to voice our grievances.
Those of you that join us in DC this coming February will be able to see firsthand the importance of our affiliation with the AHDA. Thank you, Dr. Young.
Lastly, I would like to thank everyone that helped make this conference a success. It takes a lot of work by a lot of people over an 11-month long period to pull it all together and to be prepared for all of the adjustments that take place during the weekend.
I'd like to thank my entire family for all their help and support, my fellow board members Eileen Brewer, Dan Bemowski and Kim Robbins. Eileen gets a special thank you as the event coordinator. Also, none of this would be possible without our volunteers. Thanks go out to Steve & Heather Keschinger, Dick & Bettye Wilson, Mac DuBose, Ashley Hattle, Andrew Cleminshaw, Mark Massulo, Ruthie Harper, Lisa Mingus, and April M.
Thank you also to everyone that donated items to the raffles and auction. We were able to raise a record amount of money with these very generous donations and these funds will go directly toward next year's conference scholarships.
In 2002, Clusterbusters was formed to take a pro-active role in researching for a cure for cluster headaches and find new and improved treatments.
Eventually, 6 advocates traveled to Boston and met with the administration of Harvard Medical School and convinced them of the importance of this research and they agreed to undertake the first psychedelic research project at their institution in 40 years.
On Feb 9th, 2004, an agreement was signed to begin research at Harvard University, looking at using psilocybin as a viable treatment option providing results far better than anything currently available.
The first published results from this groundbreaking clinical study of this treatment appeared in the prestigious medical journal Neurology in June of 2006. This has been an incredibly long and often frustrating process that included the discovery of BOL-148, starts and stops of every fashion, thousands of people finding relief with various new options and an unending determination to push forward past every obstacle.
The growth of Clusterbusters into an active and successful advocacy group for the entire community, built with contributions from hundreds of people that refused to let the words "can't", or "no" stop them from helping others. Along the way we have added some incredibly dedicated advocates, we have lost one of our original research team members, Dr. Andrew Sewell, added extraordinary researchers and headache specialists to our team, overcome those that have tried to stop us and will continue to push forward. There are still doors to be knocked upon, barriers to be overcome and miles to go, but we will not be denied.
Yes, it has taken 14 years, and we have moved locations, but I am both proud and pleased to announce the following IRB approved release:
Adults with chronic cluster headache, age 21 – 65, needed for a research study investigating Psilocybin in the treatment of cluster headache.
ClusterBusters, a non-profit advocacy and education group, is participating in the recruitment of subjects for a pilot study investigating the safety and efficacy of psilocybin in cluster headache. This study is taking place at the Veterans Affairs Hospital in West Haven, Connecticut, an affiliate of Yale University School of Medicine.
Earn $100 per test day. Three test days total.
Call (203) 932-5711, ext. 4335
All calls are confidential
Biological Studies Unit, VA Connecticut Healthcare System, West Haven Campus
A few details of explanation:
Congratulations and thank you to everyone that has worked so hard for all these years to make this happen.
Bob Wold
Bob's Big Pocket Guide to Cluster Headache Treatments
If you think you've tried everything and there are no new options, you're wrong.
There are many different options available today. Some of which you may have tried and others that are new. There is more research going on right now for cluster headaches than any time in history. Some brought to us by medical science, some still in the research stage that you can participate in, some that have been developed by what is known as "citizen science" (The cluster headache patient community itself) and some being developed by medical device manufacturers. New options, some coming out of labs, some from nature, some from medical engineers.
The following is a list of options you may want to consider, in no particular order.
Keeping up to date
Research & Clinical Studies
I would suggest signing up for our patient registry so you will get all the latest news and info on upcoming clinical studies.
Patient Registry
As announced at our conference in September 2015, we have several clinical studies in the works. Some of which will most likely be asking for study participants within the next 9 to 18 months.
These studies involve genetics, psilocybin, implanted devices and a couple others including one involving the psychological burden of cluster headaches. We also will keep everyone up to date on the other studies that we are working closely with the device, or research labs.
Anyone wishing to participate in these studies should be registered in our Patient Registry. In some of the studies, all participants will be invited strictly from those that are on our registry.
Some of these clinical trials will have study sites outside the United States as well as within the US. This is an international registry and we are looking for people from every country to sign up. A couple of these studies in particular will be looking specifically for people living in the UK, Germany and Canada. Please share this information with anyone you may know residing in these countries.
To register, please go to this link: http://tinyurl.com/n9ou73a Information and people will move the research forward. Please be a part of this. Just the completion of the questions on this short survey, by the thousands that are included, helps gather important information. Please share this with others you may know that suffer from clusters. If you know of anyone that does not have access to a computer, contact us at email@example.com and we will mail a written copy for completion and inclusion. To participate, please go to this link: http://tinyurl.com/n9ou73a This registry is different and separate from our mailing list that you may already have joined. Please take this extra step with us in our research and advocacy work in cluster headaches.
If the above link is broken, go here: http://survey.constantcontact.com/survey/a07e97nw2gdhuaj6cau/start
This study will not help with your current cluster headache situation, but may very well help with everyone's situation in the future. Please consider joining in if you have a close relative that also suffers from clusters and both are willing to participate. We have started this genetic study and are working with a leading researcher from the U. of Vermont and McGill University in Montreal with one of the best geneticists in the world.
Signing up for our patient registry will start the process of joining this study if you qualify.
Psilocybin Study We will also be starting a psilocybin study at Yale University along with the VA and hope to start accepting patients in 2016.
Again, everyone on the registry will be notified when this study opens for enrollment.
Eli Lilly There is one study that is currently accepting patients and we are working with Eli Lilly on this and it's very exciting if it turns out to be as safe and effective as we all believe it to be.
I would also suggest seeing if you can get pre approved for the Eli Lilly study. I don't know if there is a site close enough for you but they can let you know if one is open or if one will open in the future. They keep adding new sites in the US and all over Europe.
This is the link for the Lilly study if you are interested.
Please visit the following site for more details:
ClinicalTrials.gov Identifier:
If you are afraid of just getting the placebo, rest assured that you will be guaranteed the active medication if you complete the process.
To get to the questionnaire and see if you can take part, you should go here:
This study is enrolling now. Get started here.
For more information, visit www.ClusterTrials.com or call Lilly toll-free at 1-855-375-7139.
BOL-148: Research, Development This substance is an analog of LSD and has been around many years. The early study done by Clusterbusters showed extremely impressive results. Further study and development has long been delayed due to the usual drug development issues and not because of its efficacy. Keep your eye on it as we still believe it will be further studied and eventually developed for use.
The ATI device is commercially available in Germany, Austria, Switzerland, Sweden and Denmark. There are trials about to open in the UK, the Netherlands and Spain.
The NHF just released a news story on SPG stimulation and chronic cluster headache last week and here is the link: http://www.headaches.org/2015/12/08/cluster-headache-study-seeks-participants. I thought you might find this interesting.
Also here is a YouTube video on Dr. Papay at the Cleveland Clinic who developed the approach to implanting the device.
Currently Available Treatments
If you haven't tried it with the proper mask, at a flow of at least 15LPM, and stayed on it until the cluster ended, then you really haven't given it a fair shot.
If 15LPM doesn't do it for you, you can try a 25LPM regulator or a demand valve that allows you to breath as deeply and as quickly as possible without emptying the bag. If you are using a mask that has holes in it, tape them off. Do yourself a favor and order a cluster mask asap.
You can order the best available mask here: http://www.clusterheadaches.com/ccp8/index.php?app=ecom&ns=prodshow&ref=clustero2kit
Besides the mask you need a regulator that will go to at least 15LPM if not a 25LPM regulator. Your doc can and should write a script for a 15LPM regulator and your 02 supplier should be able to supply one to you for any size tank they send you.
If not both can be found on Ebay.
A lot of 02 info can be found on our website. www.clusterbusters.org
Click on the oxygen tab in the drop down menus.
Also, although in 2015-16 most people are finding best results using 15LPM as a minimum and many others now using 25LPM, the following abstract shows what people were using in 2008. Something you can print out and take to your doctor. If they are still prescribing based upon 1960 recommendations, they should at least catch up to 2008/2009.
If you are in the UK, sorting out the oxygen issues with NHS is best done by contacting OUCH UK first.
Psychedelic Treatments
The three main psychedelic treatments are unique in their mode of action. They are not an abortive or preventive in any of the usual sense. They are not used to abort an attack like the triptans and they are not taken every day like normal preventives. They can sometimes prevent a cycle from starting if taken early enough. They can abort an entire cycle and not just an attack. Yes they can abort an attack or low doses can end a "shadow" but these treatments are not used to replace your present abortives. When used, the object is to treat "the cycle" and not just an attack. The doses that are used are much less than what is usually taken as a recreational dose. They are taken once every 5 days and not daily.
Episodics have been known to completely break a cycle with just a few doses. Chronics usually take more doses and start spreading out the time between doses. Although starting off taken at 5 day intervals, you do not take them every 5 days for ever. The object is to use as few doses as possible, at the lowest dose that works, and work to extend the time between doses until the cycle has broken.
Most of these treatments are all illegal or restricted in some way, depending on where you live. Some things can be easily and legally ordered online.
The following link leads to all the general information on treating cluster headaches with psychedelics. Please click on all the embedded links also as there is a lot of information contained in these documents.
This paper should be read completely and has information that applies to using all the different psychedelic treatments. The most important pages to read are those that explain the warnings about additional contraindicated conditions you may have and medications you may be taking.
Contrary to what you may have heard or are worried about, there is absolutely nothing illegal or troublesome about this document or the information contained within it. As a matter of fact, this 68 page document is copyrighted in the United States and you can find a copy of it to read in the Library of Congress if you ever visit there. You may print a copy for your personal use but it's use and or publication for any other use must be granted in writing from Clusterbusters Inc.
The first and most often used psychedelic treatment is with psilocybin which is the hallucinogenic substance found in "magic mushrooms".
These have been used successfully by many people (thousands) for many years.
Most people grow their own which is fairly easy and can be done very discreetly. There are many videos online that will teach you the techniques. You can order the spores (seeds) online and the rest of the supplies can be purchased at garden shops or places like Home Depot.
The type of mushroom spores that are used are called Psilocybe Cubensis. There are many varieties but they are all very similar in the amounts of psilocybin they will contain.
Consider the possibility of investing $100.00 and you can be set up to grow your own medication for the rest of your life. Your pharmacist will be sending you Birthday cards asking where you've been all this time.
Ralphsters Spores has been helping people with clusters for many years. You can order spores from their site at:
Premium Spores is another source. Their privacy and security is excellent. They do not retain any records or credit card info. They also take visa prepaid cards. Here is their link: http://premiumspores.com/ Another one for supplies is Midwest Grow Kits. Their system is automated and it comes with a detailed how to guide. Another plus is they will ship to FedEx office locations for pickup. Here is their link: http://www.midwestgrowkits.com/
You can not get the spores and all the growing supplies and instructions all in one place, sorry.
Instructions: This is part 1 of a 5 part series and is the best online for growing your own mushrooms.
Once you get to this video just click on each follow up video by the same person.
Part one ; http://www.youtube.com/watch?v=ZHJQrsZFQdE
Additional Growing magic mushrooms video
2. LSD (lysergic acid diethylamide) There is no way of procuring this other than through illegal means. Information on the treatment is on the Clusterbusters pages and instructions are very similar to those of the psilocybin treatments. You just can't grow your own.
It has been shown to have slightly better results than psilocybin and LSA. This may be due to the fact that it is a more pure chemical than using mushrooms or seeds, and that the effects can be felt for about twice as long so it is treating the cluster mechanism for twice as long as the other psychedelic treatments.
3. LSA (Seeds) (d-lysergic acid amide )
Ordering LSA seeds is easy online. There are several sites that can be trusted and have been helping people with clusters get good product. You don't need to mention the seeds will be used to treat clusters and if you say you will be using them for that purpose, they can't send them to you and will cancel the order. They are, for legal purposes, "not for human consumption". They know what they will be used for. Ordering them is perfectly legal. If you've ever purchased Morning Glory seeds at a flower shop or from Amazon, you've had these seeds. You may have them growing in your garden.
One of the biggest warnings with the seeds that everyone needs to be aware of in the vascular constriction that comes along with these. Just like the warnings that come with prescription ergots, there are things everyone needs to be made aware and handle with care. Example: If you suffer from Reynaud's syndrome, you should either stay away completely or be very careful with low doses. You should always consult with your doctor on adding any chemicals to your routine. They are the ones that will know your medical history and other issues you may have.
One place that has been around a long time is:
I Am Shamin : http://www.iamshaman.com/
You want to order Rivea Corymbosa seeds. http://www.iamshaman.com/eshop/10Expand.asp?ProductUID=1853&ProductCode=RVC-50
You can also use Hawaiian Baby Woodrose seeds but they are a little more difficult to process and also harder to adjust doses. I would suggest the Rivea Corymbosa seeds to start.
The fewer the seeds the better in that you will then consume fewer of the ergots that are in the husks. This is why Morning Glories are the least desired method as it would take hundreds of seeds for a dose. The HBWR though are so potent that the difference in one or two seeds can make a big difference in the hallucinogenic effects. That makes it much more difficult to adjust to the lowest effective dose.
This is a link on our website for more info on the use of these seeds:
People are using up to about 100 of the RC seeds for a dose for clusters. Its good to start with a small amount (10-20) just to make sure you don't have any issues with being allergic to any of the additional chemicals found in the seeds. There are some other ergots in the seeds as noted above.
Instructions for dosing with seeds:
An effective dose is most usually 60-100 RC seeds.
Crush them the best you can and soak in water for 1-2 hours. Any longer does not help and at some point will start to degrade the LSA. After about 6 hours it will actually break down the LSA content.
You can also soak them in clear alcohol if you like. Vodka works and will extract the LSA slightly better than H2o. But water works fine.
You should add a dash of lemon juice to aid in the extraction. You can also dissolve a vitamin C tablet in the mix. You should strain the solution. You don't need to ingest the husks.
You can mix the solution with something like cranberry juice or anything that has a strong taste because on its own, the solution does not taste very good.
All the same rules about dosing with mushrooms or LSD apply to using the seeds. This includes avoiding all the usual cluster meds. See the link about warnings and use of mushrooms.
This dosing works best if used once every 5 days until the cycle is broken. After a couple of doses you should try to expand the time between doses a few days each time. But don't push this if you seem to be losing ground while waiting.
4. 5-Meo-Dalt
This is a fairly new treatment and many people have reported good results. It can be ordered online at the moment. There are different and changing laws regarding this chemical.
It does have hallucinogenic properties but just like the other psychedelic treatments, the dose is small enough that those effects are minimal for most people. Some can just take it and go to sleep avoiding all noticeable side effects. Unlike most of the other psychedelic treatments, 5-Meo-Dalt seems to be needed on a more regular basis and may not "break" your cycle in the usual sense. It is taken on an every 5 day treatment course but just like others in this class, this time period can often be expanded between doses. There is plenty of information online regarding how to obtain this chemical as well as the treatment procedure. The best and most complete paper on this subject can be found in the "files" section of the Cluster headaches facebook group. It's also the best place to ask questions on this treatment. https://www.facebook.com/groups/17789934480/
The general treatment plan and the process involved is also based upon all the same information that is found in the Clusterbusters psychedelic treatment documents. The scientific paper on 5-meo-dalt can also be found on the CB website, here:
Other treatments
This is a vitamin and supplement regimen that has shown very good results for many people. All of the information can be found here: http://www.clusterheadaches.com/cgi-bin/yabb2/YaBB.pl?num=1324046404
There is quite a bit to learn and understand on this treatment and you should read all the information, not just a "Cliffs Notes" version. It's not a difficult program to put together and will require some lab testing along the way but it can be very worth the time spent.
Most of the items on the list have been shown to be effective in treating clusters and other headache disorders on their own. Fish oil, magnesium, B vitamins etc, all have scientific data showing efficacy to some extent. Putting them all together and adding vitamin D has been more effective than any one alone. B. Kudzu Root This crazy plant that will grow across a roadway overnight has been used to treat headaches for centuries. Details can be found on our website. It's a supplement that can be purchased online or at your local health food shop. The scientific research which was carried out by Clusterbusters and Dr. Andrew Sewell can be found here: http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2008.01268.x/full
Support Therapies
Information can be found on clusterbusters.org
1. Energy Drinks
These can be used to abort an attack if used quick enough and work pretty well with "shadows" The combination of caffeine and taurine seem to be the active ingredients that help. There are many options out there and all have varying amounts of these chemicals. Find one that works best for you with the least amount of side effects. Don't over use them, but carrying one around with you can be helpful in getting through the day.
2. Ginger Tea
Again another natural herb that has long been used to treat many things over the years but has been replaced by prescription medications that oftentimes are less effective than what nature has provided. Ginger tea can be very relaxing and not just psychologically.
You also need to remember, that just because it is natural, (as with all the same suggestions here) that does not mean there can be issues and side effects and contraindications. Be sure to read the warnings found on the CB pages.3.
3. Skullcap Tea
This one is about the best one you can use if you are looking to remove some of the anxiety that you may have while taking other psychedelic treatments. It can be ordered online. If you want to try getting off of, or before getting onto, Xanax or Valium or something similarly strong and addictive, you may want to give this a try before going down that road.
4. Melatonin
Melatonin is a natural hormone that your body produces. Its levels seem to drop off in cluster patients and it helps regulate sleep among other things. There have been
some studies of its efficacy for clusters and it does help a lot of people get some sleep and eliminate some of the nocturnal attacks. Its only available with a prescription in the UK but is over the counter in the US. It can leave a person a big groggy if you wake up in the middle of the night and have to head for your 02 tank so be careful. The same can happen with some waking up in the morning. It can give similar effects as other sleeping pills. Some people have good results with as little as 3-5 mg at bedtime but others go all the way up to 20mg. Take it an hour before bedtime so that its in your system when you hit that first REM sleep.
5. Magnesium
Magnesium has also gone though a few cluster headache studies and has shown some good results. Its often used in an IV cocktail to treat both clusters and migraines in ER's. It is taken at a dose of 400mg daily and I would suggest starting it a month or so before your regularly scheduled cluster cycle is due to start for you episodics. If you are going to stay on it for an extended period of time (if its helping) then you should also add an equal amount of calcium to your diet. Magnesium will deplete your calcium stores. This is also something you may want to consider adding to your diet if you are using verapamil as it can help with the constipation that verapamil provides.
Some miscellaneous tips & notes on conventional prescription medications.
When discussing any medications, whether they are prescription, over the counter or natural remedies, it is important to remember that old adage we've all heard before, "everyone is different." Some people have much more severe cluster cycles and attacks than others. Just as some of our attacks are 10s and some are 2s, some people have cycles that are 2s and some have cycles that are 10s. One thing no one should ever feel obliged to do is either justify their pain levels or minimize the suffering they endure. No comparing is allowed. You have what you have and others have what THEY have. Some people are able to treat their cycles with low doses of medications and others need much higher doses before getting to a therapeutic level. This does not seem to have any correlation with the length or severity of their cycle. Some people can stop a cycle that that is very severe with a low dose of a preventive. Others have much less severe cycles but need very high doses of anything to get any relief.
1. Imitrex and the other triptans
Personally I am not a fan of Imitrex. It's a bit like having a relative you can't stand but is the only one that will watch your dog for a week while you go on vacation. Yes, it is effective and there is no doubt that it has saved many lives over the years. In the throws of an attack and having an injection sitting there offering relief, it's difficult to leave unused.
On the other hand, as it has been proven through studies that it can make cycles last longer and add to the frequency and intensity of attacks.
See: http://www.clusterheadaches.com/cb/yabbfiles/Attachments/Subcutaneous_Sumatriptan_and_rebounds.pdf
But if that is your choice of abortives, there are things that can make things a little better and at the same time a little safer.
Standard injections of Imitrex work the best for cluster headaches. The pills are about useless for aborting an attack as they take too long to get into your system. If you are going to use these injections, the standard dose in the injector is 6mg. It has been found that 2mg of the injections are enough to abort a cluster attack. So you are able to actually treat three times as many attacks with however many injections you are prescribed or your insurance will cover.
There are two ways around this. One is to bastardize the injector and use a Q-tip as a plunger and just inject 1/3 of the liquid at a time. There are instructions for this on You Tube as well as more detailed info on the cluster site: clusterheadaches dot com.
The other way is to ask your doctor to prescribe vials of Imitrex. You can get a small vial and empty syringes and you can measure out 2mg doses that way.
For every 1 person that these help for any extended period of time, there are 99 that range from no relief to devastating results. They do not work fast enough to treat an attack. Taking them on a round-the-clock basis provides very little relief and will most likely end up as first building a tolerance to them and ending up addicted. They will also block many other treatments that you may want to try along the way. They can also lead to rebound headaches that make everything worse in the long run. Not only can they trigger more cluster attacks, they may end up adding Medication Overuse Headaches, so in between your clusters, you have another headache disorder to deal with. You can forget any clear thinking in between your cluster attacks and can lead to a spiraling downward. If you get referred to a pain management clinic, they will try to treat your clusters with pain killers of some sort and this rarely helps, even in the short term. Please be careful. Nerve blocks that may be offered may contain steroids but not all do. These can possibly help if done properly and are usually most effective when used in conjunction with other therapies. The blocks will wear off. Specialists are getting better at these blocks as time goes on. Find one that has experience blocking for clusters.
Dihydroergotamine is in a group of drugs called ergot alkaloids. It works by narrowing the blood vessels around the brain and affects blood flow patterns that are associated with certain types of headaches. Ergots have long been used to treat headaches, including clusters. It comes in three forms. You can get prescribed injections that come in a vial and then you draw the solution into syringes. They aren't prefilled like Imitrex. It also is available in a nasal spray form and is called Migranal. The nice thing about these products is that they usually provide longer lasting relief than the triptans. There are side effects that need to be discussed with your doctor prior to using. The bad thing about them is that for some reason, even though they've been around for many years, the prices if these have skyrocketed over the last couple of years. (See additional info further down in this document)
Thirdly, some headache clinics and specialists offer an in patient IV treatment with DHE. This is often suggested to break a particularly long or bad cycle. It changes a bit from clinic to clinic but is most often a 3 to 5 day hospital stay. It often will break the cycle while you are on the IV and sometimes a little extended relief. In almost every case, the cycle will return although there is a chance it can end an episodic cycle early.
Lidocaine drops.
You need a prescription for this but it is pretty cheap and can help sometimes. For clusters you need a 4% solution and it is applied using an eyedropper. The instructions for its use can be found on our website and it is very important that it is done properly or it won't work. It is a way to apply a treatment similar to an SPG block that you can administer by yourself.
It's an abortive in the form of an anesthesia that can sometimes help you get some sleep. Lidocaine sprays do not help. Don't waste your time. The trick is to take a dropper full, lay down on your back, on your bed, with your head over the edge, tilted backward and downward, head tilted about 30 degrees toward the side of your cluster, and insert the liquid. You want to bath the nerve ganglion located in the backside of your sinus cavity with the liquid.
Verapamil. This is one of the medications that "can" produce fewer side effects but even this one can cause problems. You need to watch your blood pressure. Some people can get some relief at lower doses like 120mg or 240mg per day. Others have been known to require up to 1200mg for some relief. But the higher the dose the worse the side effects usually. Some people are able to tolerate a therapeutic dose without bad side effects but others have bad issues. One of the worst to deal with on a daily basis can be the constipation that comes with this medication. If you're going to be on it long term, you'll most likely need to find a way to fight that.
There are also a couple of serious heart complications that can arise and EKG tresting is essential in keeping ahead of any serious health issues. If your doctor isn't ordering regular EKG's, demand them or demand to get off this med. http://www.reuters.com/article/us-verapamil-headaches-idUSSCH37552320070813
Prednisone & Steroids
These are normally prescribed as interim treatments to try to cool off a cycle while other medications can be built up in your system to a therapeutic level. Sometimes for episodics a short burst can hold down the attacks until the cycle comes to its natural end. I understand the desperation people can feel at the height of a brutal cycle and how these types of medications can help get you through a particularly bad time in your life. The doses used to treat clusters are very high on the scale of dose amounts for such powerful drugs. People that require them on an ongoing basis for such things as chronic respiratory disease may be prescribed 5mg per day. Cluster people are usually starting at 60mg or 80mg. Side effects at these doses can be extreme. These aren't limited to physical effects. You may find yourself in fits of rage. You may find yourself not only wanting to eat everything in the refrigerator, but you may want to actually eat the fridge itself. Long term effects if you use these treatments to many times can include severe joint issues due to Avascular Necrosis (bone death). Your soft tissue organs are also not safe long term. Never stop these treatments cold turkey. You must slowly lower the dose as you end the prescription. If you've been on it a long time and at high doses, you need to speak with your doctor to see if you should get an ACTH injection to get your body producing cortisol, its natural version of prednisone, again. Your body will shut down producing natural chemicals when you introduce the synthetic versions, in it's own attempt to keep levels safe and stable.
Links to additional information on the above topics as well as additional research and information can be found here on the Clusterbusters website. https://clusterbusters.org/links-tools/
Tidbits & Big bits
Going to the dentist?
If you're going to have dental work done, and need a shot of Novocain, ask for the injection without the Epi. Epinephrine can induce a cluster. It's also a great idea to teach your dentist a bit about clusters and how they are diagnosed. 40% of you had dental procedures done hoping it would help your headaches/toothaches before you found out they were clusters. Teach your dentist for the next person. Toothaches do not happen every night at 3am and last just 45 minutes, EVERY NIGHT.
Don't be afraid to travel.
If your insurance company covers 02, your supplier can most likely have 02 waiting for you at a hotel you are staying. Just call and ask for a rep that handles travel plans. They'll work out a deal with a local supplier. Bring your mask and regulator. It's true that air travel can trigger an attack. I've heard it said that if you take a capsule of mushrooms prior to leaving for the airport, it can help you avoid that problem.
Pain is inevitable; suffering is a state of mind and is optional.
One of our biggest complaints as cluster sufferers is all the things that they take from us. Jobs, relationships, important events etc.
A. Marriage & Relationships
50% or marriages end in divorce. 99.9% of those do not have clusters in their lives. When we complain that someone has left us because they weren't strong enough or care enough to stay because of the clusters, this diminishes the wonderful people that stay regardless. Leaving is the normal response. Staying and supporting is the exceptional response.
B. Jobs & Workplace
Everyone loses jobs. No one stays anywhere for 35 years anymore. It's suggested to change jobs every three years if you want to make the most money and rise up in any field. Everyone has trouble holding a job because everyone has personal issues. Not only are there ways of making a living, especially in today's cyber world, your goal should be to make a "life" not a living.
C. Vacations & Events
Please do not be afraid to make plans in fear of a possible attack. There are some things that you can do to alleviate some of that fear and be able to treat an attack IF it happens. More importantly what I have found and have heard over and over is that actually going to the event will prevent an attack that may have usually come at the scheduled time. Don't let the "possibility" of an attack stop you from doing anything. If you stay at home, it was your fear that took away the event, not the clusters. Here is something to consider. Cluster used to be called "executive headaches" because people in high stress jobs (as if only executives have high stress jobs) would be fine during the week while at work and then when they headed home for the weekend and began to relax, the clusters would strike. This is caused by chemical changes in the body that are caused by stress and the release of that stress. You may sometimes cause a self inflicted wound that leaves you thinking that you did the right thing by not attending an event and then after not going, you get an attack, making you think you did the right thing by staying away. You have put yourself thru this stress/release cycle. Don't stress about it in the first place and you won't be building up all those stressor chemicals that will eventually release and cause an attack. You're even better off stressing about it and still going and being a bit stressed while there. it's when you stay home and relax and release that stress, your couch time will not be pleasant.
D. PTSD & your mental health
A big part of understanding these issues is accepting the fact that cluster headaches very often cause severe PTSD symptoms. The fears we deal with are not something that we can easily get over. Just as we should never just expect a soldier coming home from war to "just get over it" we shouldn't expect ourselves or those we support to "just get over it." PTSD is PTSD. Reach out for help. Keep reaching out until you find that help. Surround yourself with supportive people. Society oftentimes teaches us to believe that it shows weakness to ask for help. It's not a weakness, it's a necessity.
Things that don't work so don't bother.
When I say they don't work, here is my explanation. Some people may get short term relief and others may seem to get longer term results. Most or all of this can be easily attributed to a few things. There is a placebo effect, even with cluster headaches. Yes it may seem hard to believe but it is true and has been proven through numerous studies. There is also the confusion caused by the very nature of cluster headaches. Episodics go in and out of cycle, making it difficult sometimes to determine if the relief is from a medication or from a natural cessation of the cycle. With chronics, there are also high and low periods within the year. Most often caused more by seasonal changes than medication effectiveness. When people say that something was working and then stopped, this change is likely to have been caused by either the fact that the medication was never working and it was a natural change in your cycle, the placebo effect wore off, or the medication had thrown your system off its natural course for a short period of time and your brain found a way to get back on it's malfunctioning course.
1. Inadequate Oxygen. Using a nose canula and a concentrator does not work. It won't work to abort an attack and it won't work if you're thinking that if you hook yourself up and try to use it during the night to try to get sleep. The high flow oxygen treatment does not work by raising your blood/oxygen levels. Everyone's is about 98% as it is unless you have another serious problem.
2. Daith Piercings.
You can pierce your ears or any other part of your body and you will not affect the cluster headaches in any way.
3. Massage Therapy
This is not going to help your clusters in any way and could trigger an attack.
What it can do is help release some of the tension in your shoulders and neck area and help you feel a little better. It's also possible for that short time alone taking care of yourself to help you deal with the mental stress. You again have to be careful though about the stress reliever being a trigger. There seems to be a couple hundred different types of massage therapies. They will all have the same results. This includes Shiatsu, Reflexology, Reiki and Craniosacral therapy. If they help get you through the mental end of this condition, that's fine. In my opinion, donating that hour of your time, working in a soup kitchen for the poor will help as much or more, and you'll save a hundred dollars.
4. Acupuncture & Acupressure
Don't, just don't bother.
5. Biofeedback & meditation
Again these relaxation techniques may help with some of the stress involved in clusters but they may be a trigger more often than not. See massage therapy.
6. Chiropractic
Don't, just don't bother.
Addendum 1 Additional comments on some common prescription medications used to treat cluster headaches.
The following opinions are just that, my opinions based upon collecting many reports of their effectiveness and side effects. Also my personal experience in many cases (I've tried over 70 of them).
Many of these medications are used in combination with others and it's difficult sometimes to pinpoint what actually may be helping, if they are. One thing that seems common among typical cluster drug therapies is that if a single drug or combination is not working well enough, a new drug is added without removing anything from the treatment plan. It may be that an anti depressant, or anti convulsive is replaced by a different type. What happens if you are on a beta blocker and a calcium channel blocker and seem to be getting only a 20% relief in your cycle, your doctor may want to add an anti seizure med to the cocktail. Both patient and doctor don't want to chance losing even that 20% relief and hope to build upon that by adding another type of medication. This is how people end up getting on 6 or 7 different medications at the same time and still getting minimal relief.
When considering the risk versus reward of relief versus side effects, you need to consider the following. If a medication treats your clusters and gives you 80% relief and there are only a couple of minimal side effects, then it's easy to determine whether or not you want to continue on that drug regimen. But if you are on two or three or more medications and getting less than great results, its more difficult to make those risk/reward decisions. Take a good look at the total side effects you are experiencing and also the possible long term effects, and compare the totality of the effects to the relief that you are getting. It may cause you enough concern to ask your doctor about switching things up a little.
Ketamine Spray
This one is in the early stages of testing. It has shown some signs of success for some people but it's use needs to be monitored closely by the prescribing physician. There are some possible serious side effects if used improperly. If there is one important thing to remember about this drug, it is that it should be used "sparingly" and this can lead people with clusters down that slippery slope we often find ourselves. Clusters themselves don't come upon us in a sparingly fashion and when we find something that works, it's difficult not to use it as often as the attacks command.
Ketamine topical cream
This is available through compounding pharmacies and is usually rubbed into the area where the nerve ganglion is located on the back of the neck. Often described as the cluster lump.
Migranal (DHE) Spray
This is available as a generic and has been around for many years. It has become very expensive (as have many generics for some reason). There are also shortages of it from time to time. Because of the high prices and reimbursement schedules, some pharmacies may not carry it. It is an Ergot derivative so all the warnings that go with ergotamines should be followed. What is good about this versus the triptans is that this spray can work better than the triptan sprays and also, it can give you much longer pain free periods than the triptans. An Imitrex shot may only help one attack during the day and you may still have more attacks to get through that day. Its much more likely that if this helps you, it can give you 24 hours of relief. So if you're used to having 6 attacks a day, it can eliminate all of them, unlike Imitrex.
In-Patient treatments
General notes on psychedelic treatments.
Copyright © Clusterbusters, Inc, 2016
All rights reserved. Not to be republished or distributed without prior written approval from Clusterbusters, Inc.


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When it comes to online courses, Udemy is probably one of the fastest growing providers, right up there with Lynda.com, but without the need for a subscription. Lots of free and discounted courses and the list is growing every day. Of course once Udemy was well established, it was only a matter of time before the "How to Make Money With Internet Marketing" type courses started to appear and multiply. Some quite good while others are seemingly tossed together quickly to capitalize on a residual income. There are even courses on "How to Create Courses for Udemy". Again, some are pretty good while others are somewhat disposable.
Like the sideshow barkers of carnivals of old and the "snake oil" salesmen, there are also an abundance of courses on how to make tons of money on Udemy. Some of the figures seem amazing and unbelievable, yet oddly intriguing.
Just received a promo code from Udemy.com. The code START215 is valid until February 29, 2015 for anyone who would like to get 65% off almost any course
To test the waters of Udemy, I created a course for my wife who cooks Thai cuisine as a profession. The course has been up for about 6 months and so far has earned $232.50. Not exactly the thousands of dollars touted by some of the other course instructors. We followed the advice and procedures of some of the "make money on Udemy" courses, but as you can see, we're not ready to retire to some beach resort in Thailand anytime soon, based on the income. To be fair, some of the "advice" indicates that you'll rake in more profits from tech courses and "how to make money" courses. I do remain a bit skeptical about that, though I may test it out in the coming weeks.
I have created a $5 coupon code exclusively for the first 50 Strategy For Profit readers, who might want to check out the Learn to Cook Thai course. We used all the promotional methods to get the word out about her course…and then some. If you have created a Udemy course, I'd love to get your feedback.
A quick note about the reviews and tool links on this site: I am an affiliate for most every product I review or link to. I purchase these products and test them myself in order to create quality reviews. All my reviews are completed as honestly as possible. I make no promises to the vendor prior to writing my review as to the content of the review. Should you click a link on this site that takes you to a paid product, this link will be an affiliate link and I will be paid a percentage of the sales price should you decide to purchase that product.

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Picks and Pans Review: Mischief
by Amanda Quick
Witty, charming, sharply written, downright funny—this is not the language historically deployed to describe Regency romances—bodice rippers. But without such adjectives it would be hard to talk about the 12th of Quick's bestselling, economically named novels (Deception, Scandal, Ravished, Mistress).
Beautiful, anything-but-demure Imogen Waterstone has a mind as well as a fortune—and a plan to avenge what she believes to be the murder of her dearest friend, Lucy, whose husband, she suspects, did her in. To succeed in her extremely complicated scheme, Imogen turns to Matthias Marshall, the handsome, implacable Earl of Colchester (nickname: Cold-blooded Colchester), who discovered the ancient island kingdom of Zamar and founded the prestigious Zamarian Review, which is the talk of all the most fashionable London salons.
Mischief occasionally goes purple—"A wave of sweet, searing heat went through him, stoking the fire that had been smoldering in his loins…"—but Imogen and Matthias spar like Hepburn and Tracy. The 19th century has rarely been so much fun. (Bantam; $22.95)


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Tuesday, November 15, 2016
10:20 - 11 a.m.
|Dr. Patricia Paulson, professor of Science Education, Graduate School adjunct instructor, director of the STEM in K-12 Education Graduate School Certificate, and winner of the 2016-17 Faculty Excellence Award for Service
|Instructions for Guests
|Get maps and directions to Bethel University.
|Office of Academic Affairs and Friends of the BU Library
Event Description
God calls us to live a life of service; we serve by using the unique gifts and talents he has given us. Science has traditionally been seen through a white, Western male perspective. Only in recent years has the implementation of a diverse team of scientists and engineers demonstrated the value of problem solving from multiple perspectives. National and international scientific organizations continue to call for a scientifically literate society, able to address global concerns grounded in STEM fields. To accomplish this goal, high-quality STEM education must begin at the elementary level, being especially mindful of engaging both young women and men from a diversity of cultural traditions. This presentation will center around a personal, God-given passion to empower those traditionally excluded from STEM fields by instilling a growth mindset and providing a mirror lens in which to formulate their future goals. This mission can only be accomplished by serving from below to empower those most directly connected to the education of young people, and assisting them by providing vision, tools, and skills.
Contact Ann Gannon at 651.635.8717 or email@example.com.


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Books, books, books!
I'm an avid reader. A really, really avid reader. I grew up reading everything I could get my hands on (including a lot of things that weren't, ahem, age-appropriate) and as an adult I still love reading so many different things. I picked up a Kindle in about 2008, and never looked back.
Over the years, I've built up quite a backlog of technical books. Ooh, that looks good, one-click buy, and then forget about it. And there are a lot of great writers out there writing a lot of really great things, on topics I wish I knew more about but never got the time to learn. So now I'm making a pledge - to read and work through a whole pile of the e-books I already own, and expand my horizons.
I'm still building these lists, they're a work in progress, but here goes. I'll update them as I add more, or as I tick things off.
The "Definitely" pile
I'm definitely going through a bit of an Elixir kick at the moment, so the following all go straight on the list:
- Programming Elixir - Dave Thomas
- Metaprogramming Elixir - Chris McCord
- Elixir in Action - Saša Jurić
- The Little Elixir & OTP Guidebook - Benjamin Tan Wei Hao
As well as trying to get a more fundamental grip on functional programming:
- Functional Programming for the Object-Oriented Programmer - Brian Marick
- Learn You a Haskell For Great Good! - Miran Lipovača
At heart I'm a Ruby programmer though, and there are some popular Ruby-related books I'm a little ashamed to say that I haven't read:
- The Ruby Way - Hal Fulton, André Arko
- The Rails 4 Way - Obie Fernandez, Kevin Faustino
- Metaprogramming Ruby 2 - Paolo Perrotta
- Trailblazer - Nick Sutterer
- Objects on Rails - Avdi Grimm
And then there's another pile of miscellaneous books, that don't fit in any of the categories above:
- ember-cli 101 - Adolfo Builes
- Actionable Gamification - Beyond Points, Badges and Leaderboards - Yu-Kai Chou
- Building Web Reputation Systems - Randy Farmer, Bryce Glass
- Code Complete - Steve McConnell
- Clean Code - Robert C. Martin
- Rapid Development - Steve McConnell
- Pragmatic Thinking and Learning - Andy Hunt
- Practices of an Agile Developer - Venkat Subramaniam, Andy Hunt
- Exercises for Programmers: 57 Challenges to Develop Your Coding Skills - Brian P. Hogan
- Soft Skills - John Z. Sonmez
The "Maybe" pile
And of course, there's another stack of books that I own that sound cool, but I don't know if I'll ever get to reading them. Things like:
- Object Thinking - David West
- The Art of Agile Development - James Shore, Shane Warden
- Software Estimation - Demystifying the Black Art - Steve McConnell
- ng-book - Ari Lerner
- The Passionate Programmer - Chad Fowler
- Growing Object-Oriented Software Guided By Tests - Steve Freeman, Nat Pryce
But what about…?
Of course, there are some very common and popular books not listed above, such as the following:
- Confident Ruby - Avdi Grimm
- Practical Object-Oriented Design in Ruby - Sandi Metz
- Practicing Rails - Justin Weiss
- Rails 4 Test Prescriptions - Noel Rappin
The reason they're not listed? I've already read them! :D They're all really really good, and I highly recommend all of them.
Am I insane for starting such a list? Quite possibly. Will I ever finish it? Maybe. Who knows. But my first journey will be to continue reading Programming Elixir (as I'm halfway through it already), and then will continue from there! Wish me luck!
(And send me suggestions if you think I've missed any must-read books!)
Edit 5th August - Added Exercises for Programmers and Soft Skills to the list of misc books that I definitely want to read. At least I'm close to finishing Programming Elixir!


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Piecha Mercedes C63 AMG Estate body kit and powerkit
Aftermarket specialists Piecha have revealed a new powerkit and body kit for the Mercedes C63 AMG Estate. Called Rottweiler, Piecha'sRead more
Aftermarket specialists Piecha have revealed a new powerkit and body kit for the Mercedes C63 AMG Estate. Called Rottweiler, Piecha'sRead more
Porsche has revealed the new 911 GTS Club Coupe special edition. The 911 GTS Club Coupe is meant to celebrateRead more
Hennessey has revealed the full specifications and details of the new Venom F5. Hennessey says it can accelerate from zeroRead more
Earlier this week DD Customs revealed a complete aftermarket package for the Chevrolet Camaro SS. DD Customs' program for theRead more
The first photographs of the Volkswagen Amarok Power leaked over the web today, ahead of the concept's debut, which isRead more
Renault's new Megane RS 275 Trophy boasts its updated 2.0-liter turbo engine that develops an additional 10 hp, for aRead more
Modern Muscle Design is giving everyone the chance to drive away in their SEMA built, custom 2014 Mustang GT—Project MMD.Read more
Bugatti, apart from having arguably the fastest production car on the market today, they seem to also want the recordRead more
Earlier this week, DMC Tuning revealed a new aftermarket program for the Lamborghini Aventador, called DIECI. "DIECI" means "ten" inRead more
A new aftermarket program for the Ferrari FF has just been revealed by the guys from Wheelsandmore. Wheelsandmore's program forRead more
FAB Design have just revealed their new program for the McLaren 12C Spider, which is called the Terso. The FABRead more
Earlier this week, the aftermarket specialists from Onyx Concept revealed their GST styling package for the Porsche Panamera.Read more
Prior Design have unveiled their wide body kit for the Lamborghini Gallardo, which they call the PD-L800. Prior's widebody kitRead more


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[ home ] [ << ] [ >> ]
Reading Between
Reading Between began with an invitation – to join me in reading David Graeber's book Towards an Anthropologicial Theory of Value. In the late months of 2005 and early 2006 I offered to send anyone a free copy of Graeber's book, creating an informal network of readers who communicated online through email and a forum. Reading Between was partly a fragmentary conversation, and partly a simultaneous action (reading, or thinking about reading) distributed across space in several countries.
- : : : : : : : : : : : : :
Reading Between was part of the exhibition Les Formes Du Delai curated by Marie Cozette, Keren Detton and Julie Pellegrin at La Box::Bourges


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Pool Installation in East Moriches, New York
Looking for Pool Installation in East Moriches, New York?
Swimming pools provide East Moriches residents with a fun place to relax in the warm weather, and Complete Pool Service of Long Island is the best contractor to call for pool installation in East Moriches, New York. Our professional installers have worked with a wide range of pool models, styles and designs creating countless backyard paradises across the East Moriches region. Let us help you enhance your outdoor living space with a quality swimming pool.
Call for a Free Quote
(631) 237-2352
East Moriches's Pool Installation Specialists
Whether you're looking at an affordable above ground or an elaborate in-ground pool, Complete Pool Service of Long Island has qualified staff and dependable equipment to handle the project. Our installers have been working in the East Moriches region since 2005, and continue to receive up-to-date training on technology advancements and pool maintenance. Trust Complete Pool Service of Long Island staff for every step of your East Moriches pool installation, from the design stage to pool construction and landscaping.
Many East Moriches homeowners shop around for pool kits, hoping to keep this backyard project in budget. Complete Pool Service of Long Island offers affordable full pool packages including kit and installation, but we also provide expert pool installation at competitive prices for East Moriches clients that have purchased their pool kit elsewhere. Ask about our installation packages for in ground pools in East Moriches, with or without landscaping services, patio construction and water features. Complete Pool Service of Long Island strives to help New York residents stretch their home improvement dollar with reasonable rates for superior service.
Complete Pool Service of Long Island offers all of our East Moriches clients a satisfaction guarantee, providing you with peace of mind. Our staff works hard to ensure your East Moriches, New York pool installation is completed smoothly, on time and on budget. We've built a solid reputation for quality and service across the East Moriches area, and rely on customer satisfaction to maintain that reputation.
Trust Complete Pool Service of Long Island for expert service, affordable rates and a satisfaction guarantee on your pool installation in East Moriches, New York. We'll work with you at every stage of the project to ensure your swimming pool is designed and built to last. Call (631) 237-2352 today for details and to arrange for your free quotation.
Call for FREE Pool Installation Quote
(631) 237-2352
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★★★★★ - "George was so professional. I had him open my elderly parents pool. He went above and beyond for them. It is good to know good people are still out there!!'Thank you again"
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Jessica McNamara2015-09-01


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Things that we love, all combined!
Having a hobby or a job such as cosplaying is one of the best things that you can experience in your life. There are many reasons why is that, one of them is because the community of cosplay is super friendly and helpful. If you have never done any cosplay in your life, then we strongly recommend trying it out because it will change your opinion about the entire cosplay scene. A lot of people connect cosplay with only anime and they think that it is stupid to dress up as an anime character, but there is much more than just anime that people don't know about.
Dressing up as a fictional character like a superhero that you like is just the first step of cosplaying, you also have to change your mindset and become that character mentally. If you are still not a big fan of cosplay, then continue reading and you just might change your mind.
Making New Friends
As mentioned above, the cosplay community is something completely unique and everyone is very friendly oriented. You will have an easy time making new friends when you visit some cosplay show. Definitely the greatest thing about the entire cosplay hobby is that you get to meet new people each time you are cosplaying. When you meet people at a cosplay show, you will easily connect with them because usually, everyone has the same or similar interests. If nothing else, you can start talking about cosplay.
The interesting thing about cosplaying is that there are a lot of women who like to dress up. Usually, people would think that cosplaying is just for nerds, but you will be surprised when you come and see exactly how many female cosplayers there is.
Becoming Your Favourite Character
If you are wondering why people are into cosplaying, well there is no better explanation than imagining yourself as your favorite character. Remember it can be anything and anybody, from an anime, movie or even a video game. There are no limits to the costume that you will be wearing. Also, you have the option to make yourself the costume or if you don't have time or will, you can easily purchase one. However, in order to get the full experience, you have to mentally change and let the character take over you. Only then you will understand the hype that is behind this great hobby.


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SOLNA, Sweden, April 15, 2010 (Press Release) - If the members of the Swedish Paper Workers Union decide to carry out their notice of total stoppage of work at Billerud's paper mill in Skärblacka at 06.00 CET tomorrow, 16 April, production at Skärblacka will come to a complete standstill.
The loss of production is expected to affect Billerud's earnings by approximately SEK 3 million per day, and will lead to one-time costs of approximately SEK 2.5 million for firing up and closing down the soda recovery boiler. These costs are exclusive of any compensation that may be received from the Confederation of Swedish Enterprise's strike fund (Sw. konfliktfond).


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Equine Razor Wormer
Powerful, cost-effective, palatable broad spectrum wormer for horses of all ages including pregnant mares, breeding stallions, ponies and foals from 6-8 weeks. Treats and controls large strongyles, small strongyles, ascarids, tapeworms, pinworms, hairworms, threadworms, lungworms, stomach worms, stomach bots and skin lesions caused by Draschia, Habronema and Onchocerca species. Versatile, multi-dose syringe enables worming of multiple horses in the one go.
30mL syringe
Ivermectin, Praziquantel
1mL per 40kg bodyweight or one syringe per 2x 600kg horses, 3x 400kg ponies, delivered orally.
Syringe presentation. Place nozzle into side of mouth and deposit dose as far back over the tongue as possible. Raise horse's head for a few seconds after dosing to ensure dose has been swallowed.
Avoid contact with eyes and skin. Wash hands after use.


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Address: 55 New Oxford Street, Bloomsbury, London, WC1A 1BS
Age: Over 18 (Average age 21 - 35)
Open Friday and Saturday
Party with the most attractive and hip crowd!
Club 55 is a very known nightclub in London and it's recommended to be on guest list or have a VIP table booked to avoid disappointments at the door. Based on New Oxford Street in Soho, this club can be quickly described as chic and élegant! Want to party at Club 55? In this case, join our guest list or make a VIP table booking now!
Club 55, formerly known as Runway and Nylon, has been renovated and rebranded to offer you a memorable night out. The interior design of Club 55 is ultra modern with a signature fluorescent runway giving a glamorous and sexy touch to the clubs ambiance. The overall look of this club is futuristic and guarantee you will spend a great night out in London!
The really amazing parties at Club 55 attract an A-list clientele making it the celebrity venue of choice in London. This elite club is very exclusive and retains a strict door policy, so make sure to put on your best outfit and heels! The dress code of Club 55 is smart dress only. Respect the dress code in order to spend a nice night out without complications!
Club 55 London prides itself on being one of the few venues to play non-Commercial House music whilst still adding in some commercial Rnb and club classics. Now you know where to spend an extraordinary evening with London Lux Guest List!
For more info contact us at +44 (0)77 6916 9101 or email us at firstname.lastname@example.com.
Want to know about our weekly parties? Like us on Facebook and follow us on Twitter and Instagram!


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A Sporting Chance: The Dog Days of Summer
Not a breath of air disturbs the leaves on my Zsu-Zsu's favorite tree, the flowering dogwood she planted a few years ago. "A little tree for a little house," she'd grinned at the time. The oppressive heat of a Midwest August doesn't seem to bother it. In fact, it appears to thrive when the mercury tickles 100 degrees and the humidity makes being outside a test for the strongest stay-dry antiperspirant.
We placed a flower cushioned patio swing next to her little tree so we could spend summer weekend evenings rocking back and forth, inhaling the sweet smell of the Midwestern wildflowers mixed with her own cultivated roses and the mixture of marigolds, pansies, and begonias she carefully tends after the sun goes down and physical activity becomes less onerous.
That magical hour after the sun sets, she'll leave the swing and lovingly weed, spray, and water her charges while I change the channel on our ancient, 1980's style boom box to the game. Later, nearly dark, the fireflies come out and say hello and long about the 7th inning, we trudge back into our air conditioned cocoon for some ice cream or cold fruit. And if I've been a very good boy, I get both.
These are the dog days of summer, the period 20 days before and 20 days after the dog star Sirius and the sun are in conjunction, according to the ancients. That may be. But here in the Midwest, we've always seen the dog days as a time that only a dog could love. Life draining, oppressive heat, sauna-like humidity and the phenomena of the late afternoon thunderstorm that appears regularly, coming out of nowhere and disappears almost as quickly, leaving behind those jaw dropping, horizon to horizon rainbows that appear so close at times that you can almost hear the laughing Leprechaun guarding his pot of gold.
In the world of sports, the dog days mean toiling away, pushing oneself physically to perform even while common sense and the thermometer tell you to sit back and take it easy. For professional baseball players, it is the period after the All Star game and before the pennant races heat up in September when going out day after day in the heat and humidity takes not only a physical toll but makes the player pay a psychic cost as well. The mental stress, the little aches and pains all players experience during the course of a season that challenge their physical stamina, and the inexorable grind of a 162 game schedule all combine to make the dog days a test of professionalism and character.
Then there are the behemoths of the gridiron, grunting and sweating in similar heat and humidity at NFL training camps, being put through their paces by pitiless coaches who are seeking just the right combinations of players to bring them to the nirvana of the playoffs. Nearly 100 players are in most NFL training camps vying for 45 roster spots. Tempers flare regularly as the pressure to perform well at exactly the time that the head coach's eyes are turned your way as well as the relentless heat and spirited competition cause some players to butt heads like snorting bulls, tearing at each other in frustration and desperation, hoping to keep the dream alive for a few more days.
On the sedate but pressure packed fairways and greens of the golf course, the final major event of the season is set to unfold at Southern Hills in Tulsa, Oklahoma as the PGA Championship is set for this weekend. Here, the finest golfers in the world will experience for themselves the true meaning of the dog days. Temps are expected to climb into the low 100's. Hydration will be vital for both players and fans in the dangerous heat and some golfers will probably bring a couple of spare shirts, changing on the fly in the middle of their rounds as each successive garment gets weighed down with sweat making swinging the golf club - already a difficult task - that much harder.
I can recall my days in St. Louis going to Cardinals games this time of year and watching the players on the artificial surface at old Bush Stadium bouncing around uncomfortably on a field that would achieve temperatures of close to 140 degrees. The heat wafting up from the ground was incredible. Between innings, players would wrap ice cold towels around their heads while some would even immerse their fully cleated feet into pails of ice water. In weather like that, pitchers wilt after 5 or 6 innings, and playing the game becomes a test of manhood and endurance.
A similar test is administered to the gigantasaurs who are working out at NFL training facilities across the country. But it's not like the old days - not by a long shot. After a couple of high profile deaths of NFL and college athletes at training camp, much stricter rules about hydration and physical exertion have been put in place. Gone are the days when NFL coaches would have 3-a-days in the brutal heat, pushing the players to their maximum physical limits, to the point that many would collapse due to heat exhaustion, or their bodies would rebel and vomit up anything in their stomachs. Camp is still extremely tough but much more care is taken to make sure that tragedy is avoided.
My Beloved Bears used to work out at tiny St. Josephs College in Rensselaer, Indiana in the old days, which is about as far away from fun and nightlife that one can get and still be on planet earth. The players hated it. They were locked up in dorms every night and allowed out only one weekend night to get into trouble. By the time they broke camp, they were ready to eat nails and spit thunder.
Alas, those days are gone. My Beloveds now have training camp at the much more populated but still secluded Olivet Nazarene College in Bourbonnais, Illinois. The atmosphere, according to the old timers, is much more relaxed and even fan friendly. In the old days, players needed training camp to round into shape. NFL players these days stay in shape year round and training camp is just one more opportunity - following several off season mini-camps - to work on making the offense and defense play together as a unit.
There is a hint of a breeze now that the sun is going down. It is still warm and humid but the night air is beginning to cool as the bright orange orb moves below the horizon. Soon - too soon - August will give way to September and the excitement of the pennant races in baseball as well as the start of the college and NFL football seasons that will dominate the sporting landscape in America. The dog days will be forgotten as the weather changes and the leaves begin to turn.
And along about February, when everyone is heartily sick of the cold, the snow, and the biting wind, many of us will fondly recall the dog days of summer, wishing for a small taste of the misery we're all complaining about today.
Rick Moran blogs at Right Wing Nut House


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by P. Homewood, October 12, 2018 in NotaLotofPeopleKnowThat
The significance of course is that the warming of the oceans began long before any impact from CO2 emissions.
HH Lamb has written extensively about how sea temperatures in the Atlantic fell radically during the LIA. Is the warming trend since then merely a return to earlier conditions?


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