A few of you know me now, and I value everyone's advice, here is my predicament.
I suffer from chronic Cluster Headaches, a white-hot railroad spike driven into my brain above my ear, behind my left eye, with assocciated symptoms. Years ago I had up to 8 attacks a day ranging from 30 minutes to 3 hours long. Then I started taking Topiramate and the attacks were cut to 5-6 a week (not every day). The Ketamine I take helps dull the intensity.
Now, since Boxing Day, I have had attacks - 1, 2, 3, a day, every day. My dilemma is this:
Do I ramp up the amount of Topiramate I take, increasing the side-effects - specifically tiredness when I get that from Ketamine, Tramadol, Mirtazapine and Depression already, OR:
Do I go through the agony of weaning off the Topiramate to try another on the shortlist of meds with scary side-effects my Neuro supplied my GP - ending with Lithium which I'm petrified of (horror stories about mood/personality changes)?
I am really in a frying pan/fire dilemma here, your opinions matter to me.
What would you do?

Dave.