Cluster headaches

I’ve always thought it would be a better use of time to do research on conditions rather than simply pray. In one case, after doctors had near given up on figuring out what was causing a family friend’s son’s high fever, said family friend read up and suggested that his son may have dengue to the doctors. Turns out he did - doctors had not tested for dengue because it wasn’t dengue season.

Around 2017-2018 or so I started getting cluster headaches.

DISCLAIMER: THIS IS NOT MEDICAL ADVICE and TALK TO A HEALTHCARE PROVIDER INSTEAD.

Here’s my personal summary of what could help (simply a collection, no comments yet). Intended only for me to reference and track how cluster headaches are talked about online.

Vitamin D3 program (google it or go to vitamindwiki.com). Also on clusterbusters. Seems to be the most effective.

I came to the conclusion that my headaches were caused by increased pressure on the trigeminal nerve inside my right nostril. I try to stay hydrated to keep natural moisture, but more importantly, I try to keep the nostril very clean. When I feel an initial symptom starting up, I get something wet (paper towel, finger, whatever) and start cleaning any excess buildup away from my nostril’s inner wall.

From https://www.reddit.com/r/ClusterHeadaches/comments/ec77o9/headache_free_for_four_years/

Emgality (injection) Toradol (abortive; prefer Emgality) Psilocybin Sphenopalantine ganglion (SPG) nerve block (catheter) Lidocaine nasal spray Botox (on masseter muscle due to temporomandibular joint pain) [Adverse effect] Verapamil -> Edema [Adverse effect] Sumatriptan -> rebound headaches [no effect] Gabapentin

https://www.reddit.com/r/ClusterHeadaches/comments/ykusui/advice_from_a_registered_nurse_and_ch_patient/

Possibly vagus nerve related

Interestingly, stimulating the Vagus nerve by going into the cold/applying. Massaging the back of the neck can also stimulate the Vagus nerve. Humming can also stimulate the vagus nerve. Sleeping on your right side (back is the worst). Devices like Gammacore for VNS. link from a certified mental health professional licensed in the US

Ice cold slushies, water, etc. as an abortive. Applying cold/ice pack to the head.

Source: Reddit link, many, many recommendations.

Pressing on the back of your neck

From: https://www.reddit.com/r/clusterheads/comments/38qtnz/what_are_your_tricks_to_abortprevent_attacks/crz8ljf/

ASMR (not that kind). Yawning repeatedly, scratching the scalp, hot shower with water on head, neck and back. And this Rife frequency video

From: https://www.reddit.com/r/ClusterHeadaches/comments/wfs3p4/7_days_in_a_row_aborted_every_cluster_headache/

Humming

Lost link

Sleep related

Fixed circadian cycles [CC] and Melatonin [M]

CC: https://www.reddit.com/r/clusterheads/comments/38qtnz/what_are_your_tricks_to_abortprevent_attacks/iqonhfi/
CC: https://www.reddit.com/r/clusterheads/comments/38qtnz/what_are_your_tricks_to_abortprevent_attacks/j0cwk0c/
M: (10-15 mg) https://www.reddit.com/r/clusterheads/comments/38qtnz/what_are_your_tricks_to_abortprevent_attacks/il5sitc/
M: (20 mg) https://www.reddit.com/r/clusterheads/comments/38qtnz/what_are_your_tricks_to_abortprevent_attacks/jgouja9/ M: https://www.reddit.com/r/clusterheads/comments/1akmrwh/10mg_melatonin_before_bed/

Miscellaneous

Couple of shots of lemon juice to make it easy to deal with the pain

(what!) https://www.reddit.com/r/clusterheads/comments/38qtnz/what_are_your_tricks_to_abortprevent_attacks/jhnq4gn/

Pressing the point/skin flap between your thumb and finger

Lost link

Running really fast or vigorous exercise like 20 minutes of jumping jacks

From: https://www.reddit.com/r/clusterheads/comments/38qtnz/what_are_your_tricks_to_abortprevent_attacks/houzlmz/ and https://www.reddit.com/r/clusterheads/comments/38qtnz/what_are_your_tricks_to_abortprevent_attacks/hz2x37v/ and https://www.reddit.com/r/clusterheads/comments/38qtnz/what_are_your_tricks_to_abortprevent_attacks/j44jxtp/

5-Meo-DALT

From: https://www.reddit.com/r/clusterheads/comments/38qtnz/what_are_your_tricks_to_abortprevent_attacks/cs7y00x/

Austin Goh Cluster headaches on YouTube

Found on https://www.reddit.com/r/clusterheads/comments/38qtnz/what_are_your_tricks_to_abortprevent_attacks/ and 1 more link.

Above link has other recommendation too, including
4 recommendations for Excedrin (one saying it caused rebound headaches)
2 recommendations for masturbation
2 recommendations for sleeping sitting up
Many recommendation related to breathing/clearing the sinuses/nasal inhalers like anefrin/Flonase Couple of recommendations for a TENS unit

Appendix

To process:

• https://www.youtube.com/watch?v=CGjdgy0cwGk
• https://vitamindwiki.com/Cluster+and+Migraine+headache+treatment+protocol+-+Sept+2023#Talk_to_your_doctor
• https://vitamindwiki.com/pages/cluster-headaches-treated-by-high-dose-vitamin-d-etc-interview-and-transcript/
• https://vitamindwiki.com/Cluster+headaches+virtually+eliminated+in+7%2C000+people+with+high-dose+vitamin+D+and+cofactors+-+Feb+2022
• https://en.wikipedia.org/wiki/Cluster_headache
• https://www.clusterheadaches.com/cgi-bin/yabb2/YaBB.pl?num=1674489873
• https://www.clusterheadaches.com/cgi-bin/yabb2/YaBB.pl?num=1324046404/900#900

AI-generated summary of content in links

Wikipedia - Cluster Headache Overview: Cluster headache is a neurological disorder characterized by episodes of severe unilateral headache attacks around the eye and temple, lasting 15-180 minutes. About 75% of untreated attacks last less than 60 minutes. The condition affects ~0.1% of the population, with men affected 4x more often than women (fact-check: ratio now estimated at 2.5-3:1; the historically reported 5-7:1 ratio has decreased as diagnosis of women improved). Onset typically occurs between ages 20-50. The pain is considered among the most severe known to medical science—Dr. Peter Goadsby notes: “Women with cluster headache will tell you that an attack is worse than giving birth.” The condition shows remarkable periodicity, often striking at the same time each day (“alarm clock headache”), with cluster periods typically lasting 8-10 weeks yearly. The hypothalamus is believed to play a central role due to this circadian/circannual pattern. Standard treatments include high-flow oxygen (12-15 L/min for 15-20 min, ~70% effective) and triptans for acute attacks; verapamil is the recommended first-line preventive. Research into psilocybin and other tryptamines is ongoing.

Clusterbusters D3 Vitamin Therapy Protocol: The protocol offers two loading schedules to rapidly elevate vitamin D3 levels. The two-week schedule starts with 50,000 IU daily (week 1), then 40,000 IU for six days (week 2), before dropping to 10,000 IU maintenance. The four-week alternative uses 20,000 IU daily plus weekly 50,000 IU loading doses. The therapeutic target is serum 25(OH)D concentration near 80 ng/mL. Dosing adjustments are recommended based on BMI. Cofactors are emphasized as essential alongside vitamin D3.

VitaminDWiki Treatment Protocol: A comprehensive protocol combining high-dose vitamin D3 with cofactors and antihistamines. Loading involves 50,000-100,000 IU daily for 5-18 days (totaling ~600,000 IU). Target serum levels vary: 80-100 ng/mL for episodic CH, 90-120 ng/mL for chronic CH. Maintenance typically requires 10,000-30,000 IU daily. Essential cofactors include magnesium (400mg), omega-3 fish oil, vitamin K2, and B-complex. For resistant cases, the “Full Monty” adds turmeric, quercetin, resveratrol, and 8g vitamin C daily. Key steps: baseline bloodwork, accelerated loading with doubled magnesium, 2.5L daily hydration, retesting 15-30 days post-loading, and ketogenic diet consideration.

VitaminDWiki 7,000 Patient Study: Pete Batcheller’s research documented 81.3% of cluster headache sufferers achieving significant reductions (≥70%) in frequency, severity, and duration. Approximately 60% achieved substantial pain-free responses. Pre-treatment serum levels averaged 22.8 ng/mL; post-treatment averaged 83.4 ng/mL. When subjects stopped vitamin D3, cluster headaches typically recurred within 7-8 days. Daily cost remains under 50 cents.

VitaminDWiki Interview with Pete Batcheller (127 min video transcript): Pete Batcheller, a 77-year-old retired Navy fighter pilot with a chemistry degree, developed the anti-inflammatory regimen after discovering his own cluster headaches disappeared when he spent time outdoors in summer (vitamin D from sun exposure). Key points from the interview:

The Protocol:

• Loading dose: 600,000-700,000 IU total over 5-12 days. Options: 100,000 IU/day for 6 days, or 50,000 IU/day for 12 days. For chronic/migraine: add nanoemulsion sublingual D3 for 140,000 IU/day for 5 days.
• Maintenance: 10,000 IU/day, or one 50,000 IU capsule weekly (Bio-Tech D3-50 water-soluble recommended).
• Target serum level: ~80 ng/mL (200 nmol/L). Some need higher.
• Essential cofactors: Magnesium 400mg (double during loading), Zinc, Boron, Vitamin A, Vitamin K2 (MK-4 and MK-7), Omega-3 fish oil, Vitamin B complex. Most found in Kirkland Adult 50+ Multi except K2 and sufficient magnesium.
• Take with largest meal of the day (stomach acid needed for absorption).

The “Full Monty” for non-responders (if no improvement after 5 days):

• Turmeric/curcumin: 3g/day
• Resveratrol: 3g/day
• Quercetin: 3g/day
• Omega-3 fish oil: increase to 3-4 capsules
• Vitamin C: 6-8g/day (dissolve powder in water, sip throughout day)
• Melatonin: 10mg/day

How it works: Vitamin D3’s active form (calcitriol) enters cells and binds to the vitamin D receptor (VDR), a nuclear transcription factor. This complex then binds to DNA at vitamin D response elements (VDREs), triggering mRNA production that up-regulates beneficial genes and down-regulates harmful ones. Over 2000 genes have vitamin D receptors (fact-check: ~2000 refers to vitamin D response elements (VDREs) in the genome; the number of genes directly regulated by VDR is closer to 900). For cluster headaches specifically, calcitriol inhibits CGRP (calcitonin gene-related peptide) transcription—a key inflammatory neuropeptide in migraine/cluster pathophysiology. It also inhibits Substance P, VIP, and PACAP (fact-check: CGRP inhibition by vitamin D is supported by research; the effects on Substance P, VIP, and PACAP are Batcheller’s hypothesis with limited direct evidence). Vitamin D also modulates immune function, and 70% of the immune system is in the GI tract (fact-check: this figure is imprecise; gut-associated lymphoid tissue (GALT) represents a major portion of immune tissue, but “70%” is a rough estimate that varies by source and definition).

Critical lab tests (before starting and at 30 days):

• 25-OH vitamin D (target: 80+ ng/mL)
• Calcium (should stay in normal range)
• PTH/Parathyroid hormone (should drop as D3 increases—mirror image of calcium) If PTH doesn’t drop, you have vitamin D resistance—keep loading while monitoring labs.

Results from 313 completed surveys:

• 82% experienced significant drop in frequency (from ~3/day to ~3/week on average)
• 64% experienced complete cessation of cluster headaches
• Episodic sufferers: 87% response rate
• Chronic sufferers: 64% response rate
• Average baseline 25-OH: 24 ng/mL → Post-treatment: ~80+ ng/mL

Safety:

• No deaths from vitamin D3 supplementation ever recorded (fact-check: while deaths are extremely rare, there have been isolated case reports of fatal vitamin D toxicity, typically from accidental massive overdoses or manufacturing errors; the claim reflects that therapeutic supplementation has an excellent safety record)
• LD50 in rodents would translate to ~128 million IU in humans (impossible to consume)
• Safe to take with standard CH medications (sumatriptan, oxygen, etc.)
• Verapamil can be tapered off after favorable response
• 1% of people starting may already be hypercalcemic (hence the baseline labs)
• Avoid vitamin D2 (synthetic, less effective, blocks D3 receptors) (fact-check: D2 is plant/fungal-derived, not strictly synthetic; D3 from lanolin is also produced semi-synthetically. D2 is less effective and may compete with D3 for receptors)

Additional recommendations:

• 2.5 liters of water daily (coffee doesn’t count—it’s a diuretic)
• Ketogenic/Atkins diet: avoid sugars, grains, grain oils (inflammatory)
• Exercise (even just walking)
• Lifestyle commitment: “This is not a single cure—you need to stay on it for life”

ClusterHeadaches.com Forum Discussions: Forum threads emphasize the D3 regimen’s effectiveness, with users reporting multi-year pain-free periods. Complementary approaches discussed include oxygen therapy, GammaCore device (effective for acute use), and the antihistamine “Full Monty” protocol for breakthrough attacks. Notable observations: combining D3 with Verapamil may worsen symptoms for some; B-complex cessation can trigger breakthrough attacks. Individual variation in treatment response is emphasized, along with the importance of lab monitoring.

Reddit Thread - “What are your tricks to abort/prevent attacks” (10+ years of replies):

Highest-voted preventatives:

• Vitamin D3 Regimen: Multiple users report complete cycle elimination. One user (Astromike23) reported D3 cleared their cycle in 48 hours and they’ve skipped clusters for 15+ years since. Typical maintenance: 5,000-10,000 IU daily depending on sun exposure. Must monitor 25(OH)D levels with doctor.
• Psilocybin mushrooms: Repeatedly mentioned as “life-saving.” Typical dose: 2-3g dried to break a cycle, with 5-7 days between doses. Some use microdoses (<1g) but report less effectiveness. One user reports 4+ years pain-free from regular dosing every 3 months. Legal issues noted as barrier.
• DMT: Several users report 100% success rate aborting attacks. One user broke an entire cycle by “blasting off every time I felt an aura” - 10 times in 3 days.
• Melatonin: 10-20mg before bed reported effective by multiple users.
• Verapamil: Works well for some but causes peripheral edema; one user notes D3 only worked after stopping Verapamil completely.

Highest-voted abortives:

• Oxygen: Considered gold standard. 12-15+ L/min via non-rebreather mask. Most report relief in 10-15 minutes. One user notes O2 concentrators don’t work (not 100% oxygen, lower flow).
• Energy drinks/caffeine: Red Bull frequently mentioned. Must chug quickly at first sign of attack. One user: “If I down it quickly as an attack starts, I can usually mitigate it to a shadow.” Coffee also works but slower.
• Cold/brain freeze method: Highly endorsed. Slushies, ice water through straw to roof of mouth, ice cubes held against palate. Multiple users report instant relief. Theory: stimulates same nerve (vagus?) that causes cluster headaches. One user: “I chug ice water through a straw, keep the straw at the roof of my mouth. It forces an ice cream headache and hurts like a motherfucker for a bit, but then starts to fade!”
• Running/intense exercise: Multiple confirmations. Must catch it early. One user tracks 56/60 successful aborts via 90-second sprints on treadmill. Theory: increased oxygen to brain or endorphin release.
• Sumatriptan injections: Fast-acting but some report rebound headaches with overuse.

Other reported methods:

• Hot showers (water on head/neck)
• Pressing hard on back of neck (occipital nerve)
• TENS unit behind ear
• Masturbation/sex (multiple independent reports)
• Sleeping sitting up
• Push-ups/vigorous exercise
• Lidocaine nasal spray
• Capsaicin/cayenne pepper in nostril
• Wim Hof breathing techniques

Reddit - “Headache free for four years”: User discovered their cluster headaches were caused by pressure on the trigeminal nerve inside their nostril. Solution: keeping the nostril clean and hydrated. When symptoms start, cleaning any buildup from the nostril’s inner wall causes symptoms to retreat within minutes. Minor nosebleeds are acceptable tradeoff vs. “rocking in the dark in fetal position.”

Reddit - “Advice from a registered nurse and CH patient” (25+ years experience):

• Emgality (galcanezumab injection): “Truly saved & returned me to a normal and 98% pain free life”
• Toradol (ketorolac): NSAID injection that completely aborted acute attacks (most ERs don’t know this works for CH)
• SPG nerve block: Catheter device (no needles) to the sphenopalatine ganglion can “reset the system” and interrupt pain cycle
• Lidocaine nasal spray 4%: For acute attacks, hits membrane above SPG
• Botox: Especially on masseter muscle for TMJ-associated pain
• Traditional methods rated “garbage”: Oxygen only partially helps, Verapamil caused edema, Gabapentin no effect, Sumatriptan caused “terrible rebound attacks”

Reddit - “My cluster headache cure” (brain freeze/cold method): User discovered cold slushies and blasting AC can prevent/abort clusters 100% of the time if caught early. Theory connects to vagus nerve stimulation. Multiple confirmations in replies. One user: “Medical_Eggplant_591: This actually worked for me, which is insane. Thank you for sharing. My life has been so much more manageable.”

Reddit - “7 days in a row aborted every cluster headache” (ASMR method): User reports aborting attacks within 5 minutes by triggering ASMR: yawning repeatedly, scratching scalp, hot shower on head/neck/back, and a specific Rife frequency video. Others confirm ASMR/yawning helps. Also mentions humming and singing provide some relief.

Possible mechanisms

Understanding why cluster headaches occur helps explain why such diverse treatments (vitamin D, oxygen, cold exposure, psychedelics, exercise) might all provide relief.

The Hypothalamus Theory

The hypothalamus—the brain’s “biological clock”—is strongly implicated in cluster headaches. Evidence:

• Circadian patterns: Attacks strike at the same time daily (“alarm clock headaches”)
• Circannual patterns: Clusters often occur around solstices/equinoxes or seasonal changes
• PET scans: Show hypothalamic activation during attacks
• Sleep connection: Attacks frequently occur during REM sleep; melatonin (which the hypothalamus regulates) helps some sufferers

This may explain why fixed sleep schedules, melatonin, and circadian rhythm management (consistent wake times, blue light restriction) help prevent attacks.

The Trigeminal-Autonomic Reflex

Cluster headaches are classified as “trigeminal autonomic cephalalgias” (TACs). The trigeminal nerve (which innervates the face, eye, and sinuses) and the autonomic nervous system become pathologically linked:

• Trigeminal nerve activation → releases inflammatory neuropeptides (CGRP, Substance P, VIP, PACAP)
• These cause vasodilation, inflammation, and the characteristic pain around the eye
• Autonomic symptoms follow: tearing, nasal congestion, drooping eyelid, pupil constriction

This explains why SPG (sphenopalatine ganglion) nerve blocks, lidocaine nasal spray, nostril cleaning (reducing trigeminal irritation), and capsaicin in the nostril might work—they all target this pathway.

The CGRP Connection

Calcitonin gene-related peptide (CGRP) is elevated during cluster attacks and is a major player in the pain cascade:

• CGRP causes vasodilation and neurogenic inflammation
• It’s released from trigeminal nerve endings
• Blocking it provides relief

This is why Emgality (galcanezumab, a CGRP-blocking monoclonal antibody) works for some sufferers. It’s also where vitamin D3 enters the picture: calcitriol (active vitamin D) binds to the vitamin D receptor (VDR), which then binds to DNA and modulates gene expression. Research confirms vitamin D can inhibit CGRP transcription. Batcheller’s hypothesis extends this to other neuropeptides (Substance P, VIP, PACAP), though direct evidence for those is limited. This genetic mechanism explains why D3 takes days to work—it requires gene expression changes, not just blocking a receptor.

The Inflammation/Histamine Hypothesis

Many effective treatments share anti-inflammatory or antihistamine properties:

• Vitamin D3, omega-3s, turmeric, quercetin, resveratrol (the “Full Monty”)
• Histamine injections can trigger cluster attacks in sufferers
• One user achieved 3.5 years remission with daily Claritin + low-histamine diet
• Benadryl helps some sufferers

The trigeminal ganglion contains mast cells that release histamine. If histamine is a trigger, then antihistamines and anti-inflammatory agents would logically help. Vitamin D also modulates immune function—the gut-associated lymphoid tissue (GALT) is a major immune organ, and D3 influences T cells, B cells, and inflammatory cytokines.

The Vagus Nerve Connection

The vagus nerve regulates inflammation via the “cholinergic anti-inflammatory pathway.” Vagal stimulation can reduce systemic inflammation. This may explain why such diverse interventions help:

• Cold exposure (slushies, brain freeze, ice on palate): Cold activates the vagus nerve
• Humming/singing: Vibration stimulates vagal tone
• GammaCore device: Direct vagus nerve stimulation
• Exercise: Intense exertion increases vagal activity
• Sleeping on right side: May affect vagal tone (back sleeping is worst)
• Deep breathing/Wim Hof: Controlled breathing modulates the vagus nerve

The brain freeze method may work by stimulating the sphenopalatine ganglion (located near the palate) which has connections to both the trigeminal and autonomic systems—essentially “resetting” the pathological reflex.

The Oxygen/Vasculature Theory

High-flow oxygen is the gold standard abortive. Why it works:

• Cluster headaches involve vasodilation of blood vessels around the trigeminal nerve
• Oxygen causes vasoconstriction, counteracting this (fact-check: the exact mechanism is still unclear; vasoconstriction is one hypothesis, but some research suggests oxygen may work via CGRP inhibition, trigeminal nerve modulation, or other pathways—the mechanism is not definitively established)
• It may also reduce CGRP release
• The “trigeminal vascular complex” (blood vessels in/around the trigeminal ganglia) is a key site

This explains why caffeine (a vasoconstrictor) works as an abortive, and why exercise/running might help—it changes blood flow patterns and oxygenation rapidly.

The Serotonin/Tryptamine Connection

Triptans (sumatriptan, etc.) are serotonin receptor agonists. Psychedelics (psilocybin, LSD, DMT) also act on serotonin receptors:

• Both bind to 5-HT receptors, particularly 5-HT2A (fact-check: triptans primarily bind to 5-HT1B and 5-HT1D receptors, NOT 5-HT2A; psychedelics like psilocybin/LSD primarily bind to 5-HT2A. They work on different serotonin receptor subtypes)
• DMT is structurally similar to sumatriptan
• Psychedelics may “reset” dysfunctional neural circuits
• They may also promote neuroplasticity, allowing the brain to break the cluster cycle

This may explain why a single psychedelic dose can end an entire cluster cycle (not just abort one attack)—it’s potentially rewiring the hypothalamic/trigeminal dysfunction rather than just treating symptoms.

Putting It Together

Cluster headaches likely involve multiple interacting systems:

1. Hypothalamus sets the clock (when attacks occur)
2. Trigeminal nerve generates the pain signal
3. Autonomic system produces accompanying symptoms
4. CGRP and other neuropeptides drive inflammation and vasodilation
5. Histamine/mast cells may be triggers
6. Vagus nerve can modulate the inflammatory response

Different treatments target different parts of this system:

This multi-system involvement explains why no single treatment works for everyone, and why combining approaches (e.g., D3 regimen + oxygen for breakthroughs + circadian management) often works better than monotherapy.

AI-generated additional thoughts

Pattern Recognition Across Sources: The most striking pattern is the convergence on vitamin D3 as a primary intervention. Multiple independent sources (Clusterbusters, VitaminDWiki, forum communities, Reddit users across 10+ years) report similar efficacy rates and protocols. One Reddit user’s 15-year success story with D3 is particularly compelling. The consistency suggests this isn’t merely placebo effect or confirmation bias.

The Inflammation/Histamine Hypothesis: Many treatments share an anti-inflammatory or antihistamine mechanism: vitamin D3, omega-3s, turmeric, quercetin, Benadryl, and even cold application. The registered nurse’s mention of CGRP (calcitonin gene-related peptide) connects to this—Emgality is a CGRP-blocking monoclonal antibody. One Reddit user reports a histamine intolerance was their trigger, and daily Claritin + low-histamine diet ended their cycle in 3 days with 3.5 years remission since.

Vagus Nerve Connection: Your “Possibly vagus nerve related” section is strongly supported by the Reddit content. The brain freeze/cold method works for many users, and several explicitly mention vagus nerve stimulation. The vagus nerve regulates inflammation through the “cholinergic anti-inflammatory pathway.” This could explain why diverse interventions work:

• Cold exposure (slushies, ice on palate, cold showers)
• Humming/singing
• GammaCore VNS device
• Sleeping position (right side better than back)
• ASMR/yawning
• Exercise (vagal activation during intense exertion)

Circadian/Sleep Pattern: The hypothalamus connection is well-established per Wikipedia and strongly supported by user experiences. The condition’s “alarm clock” nature (attacks at same time daily) points to hypothalamic dysfunction. Melatonin (10-20mg) works for many users. One user’s Apple Watch sleep tracking revealed correlation: >1 hour deep sleep = significantly fewer attacks. ZzzQuil before bed helps some users by ensuring adequate deep sleep. Managing circadian rhythm (consistent sleep times, blue light restriction) has kept one user in remission.

Trigeminal-Autonomic Reflex: The nostril cleaning approach from the “headache free for four years” post directly involves the trigeminal nerve. The SPG (sphenopalatine ganglion) nerve block mentioned by the RN also targets this pathway. Lidocaine nasal spray works by anesthetizing the membrane above the SPG. Capsaicin in the nostril is another trigeminal intervention some users report success with.

The Oxygen Question: While oxygen is the medical gold standard (~70% effective per Wikipedia), Reddit experiences are mixed. Some report it as essential; others find it merely shortens attacks or doesn’t work well. The RN rates traditional methods including oxygen as “pretty much garbage.” Key insight: flow rate matters significantly—5 L/min is too low; 15-25 L/min recommended. O2 concentrators typically don’t work (lower concentration, lower flow).

Exercise as Abortive: The running/exercise abortive is remarkably well-documented. One user tracked 56/60 successful aborts via 90-second treadmill sprints. Proposed mechanisms:

• Increased blood oxygen (mimicking O2 therapy)
• Endorphin release
• Vagal stimulation
• Rapid breathing affecting CO2 levels
• Heart rate elevation changing blood flow patterns

Psychedelics: Psilocybin and DMT are repeatedly mentioned as highly effective, with some users calling them “life-saving.” The mechanism may relate to serotonin receptor activity (similar to triptans) or neuroplasticity effects. DMT’s chemical similarity to sumatriptan is noted in Wikipedia. Dosing protocols vary: some use full trips (5g mushrooms, breakthrough DMT doses), others microdose. Legal barriers remain the primary obstacle. LSD is also mentioned as effective.

Potential Gaps to Explore:

• Magnesium: Appears as cofactor in D3 protocols but one user reports it alone helped significantly for 30 years of CH.
• B12: One user (baronewu2) reports 12 years pain-free on “Super B12” after decades of headaches.
• Taurine: The active ingredient in Red Bull; some users take it as standalone supplement (5g daily). (fact-check: caffeine is the primary active ingredient in Red Bull; taurine is one of several ingredients. Red Bull contains ~1000mg taurine and ~80mg caffeine per 8.4oz can)
• Diabetes connection: One user’s clusters stopped completely after insulin treatment for latent Type 1 diabetes.
• Barometric pressure: Multiple users note attacks correlate with weather/pressure changes.

Caution Notes:

• Sumatriptan can cause severe rebound headaches for some users (the RN warns strongly against it)
• Verapamil may need to be stopped for D3 to work effectively
• Opioids are explicitly not recommended and may worsen the condition
• Too much caffeine between attacks may trigger attacks (but works as abortive during attack)
• Alcohol is a well-known trigger during cluster periods