_Thufir_

I know I can't understand, as I've never had cluster headaches, but I have spent two weeks at an in-patient headpain treatment center for migraine, among other similar adventures. The head pain clinic I went to led me to believe that the rebound effect on opiates meant using them more commonly than twice a week did not lead to a lower average level of pain in the long run, whereas they could be effective when used no more than two days a week. I have no medical education though and was pretty much just trusting they were right on that.

And, from what I've heard of clusters, that's a level of pain that precludes weighing long term considerations. Anything that can possibly ease the pain is understandable. For vanilla migraines, my personal experience has been that the acute treatments (opiates, etc.) do work a lot better if used infrequently. Clusters are a whole different beast though.

edit: Also, props on being able to continue academically through this. I can't fathom functioning well enough to accomplish what you are doing with that level of pain.

First, ouch. My sympathies.

Second, are you concerned about the long term effects of using opiods five times a week? Or whether it's actually effective pain management? Do your doctors disagree that http://en.wikipedia.org/wiki/Medication_overuse_headache is a potential issue?

Third, how much worse are cluster headaches than migraines?

I'm (obviously) not the OP, but would like to point out that clusters and migraines are very different things. Migraines (which I get most days) are unpleasant. Clusters are the first medical condition that shows up when you google "worst pain known to man", and are colloquially known as "suicide headaches".

Re-reading my comment, I have to apologize to you. I wasn't saying you don't have cluster headaches, or attempting to minimize your symptoms. It was aimed at your reference to a "cluster migraine". Some people, such as OP, suffer from both head pain conditions, but one is not a variant of the other. The symptoms are quite different. You might find http://www.hopkinsmedicine.org/neurology_neurosurgery/specialty_areas/headache/conditions/ interesting reading to find what best matches your symptoms.