We have so much in common! I get cluster headaches too though not as continuously as you; it's sort of seasonally triggered for me and can last for up to around 9 months, but I do get breaks. Topiramate was the only thing that ever helped me, but strangely when I was taking anti-depressants at the same time it stopped working for me, and now it doesn't even work for me on its own. Which leaves me a bit stranded. Other prophylactic drugs I've tried either don't work (most everything), or have given me permanent injury via their side effects (depakote! grr.).

I actually get what seems like almost every kind of headache there is, and some trigger the others.. I get tension headaches because of some botched spinal surgery I'll forever be suffering the after effects of, and migraine with aura since I was a kid. Clusters started in about my mid 30s.

It's probably no coincidence that it's only now I've been cluster free for 6 months or so that my last major depressive episode finally had a chance to break. I don't think people that haven't had experience with persistent severe pain can entirely imagine just how much it can impact one's mental and spiritual powers. It really does stack the deck, I feel for you.

Is the topiramate still working well for you?

P.S., Your white hot railroad spike in the eye description is indeed apt.. very similar to how I describe mine to my friends, right before they wince. I always feel badly afterwards, but I'm just trying to be accurate..