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Topic: CH treatment flowchart (Read 347 times) |
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CJohnson
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CH treatment flowchart
« on: Jul 7th, 2003, 1:24pm » |
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Suppose a person discovers they have CH. Assume this person has no experience with medications and no history of any other kind of condition. What should be the first measures this person takes, in terms of treatment modalities? If that didn't work, what should be plan B? If that doesn't work, what should be plan C?
Example:
1. Verapamil 240mg for prev. Imitrex inj. for abortive.
If that doesn't work..
1a. Increase verapamil
If that doesn't work..
2. Verapamil/Lithium combo. Maxalt for abortive.
If that doesn't work..
3. DHE I.V.
4. Prednisone
5. Botox
6. Occipital block
7. etc...
Should treatment start with the least dramatic and get more drastic with each new approach? What is the least drastic approach? What is the most drastic approach? Should episodic sufferers be treated with a different approach than chronic sufferers?
PFDANs
-Curtis
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eyes_afire
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Re: CH treatment flowchart
« Reply #1 on: Jul 7th, 2003, 5:49pm » |
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Hi Curtis. I kinda outlined my personal 'preventative flowchart' on the meds board in the 'Tell me what works, Please' thread. It will be nearly impossible to make a generic flowchart because everyone is different. Some people can't tolerate verapamil or lithium. All depends on the individual. The 3 main factors I consider are:
1. effectiveness
2. side effects
3. cost
I hadn't considered the IV DHE, but if you're a poor bastard like me, the cost pushes it to the bottom of the list. Also, if you're a poor bastard like me, shrooms get pushed higher up the list... but I've been that route. I would probably have to reconsider shrooms if I ever get to where I'm desperate enough to try anti-seizure stuff.
I always opt for the least side effects if possible. I've had some downright frightening side effects (some from meds not related to CH). I got into BIG trouble from an antibiotic on one occasion and Paxil on another occasion. There's nothing more demoralizing than taking a med only to later realize that it has caused a bigger problem than what it was supposed to treat.
--- Steve, one of many...
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eyes_afire
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Re: CH treatment flowchart
« Reply #2 on: Jul 7th, 2003, 6:26pm » |
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... almost forgot.
LISTEN to Bob P. Try indomethacin early on... like first. It is ridiculously cheap.
--- Steve, one of many...
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Ueli
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Re: CH treatment flowchart
« Reply #3 on: Jul 7th, 2003, 6:32pm » |
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I've heard that oxygen is a good abortive too, and cheaper than Imitrex.
Why isn't it in this flowchart? 
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oringkid
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Re: CH treatment flowchart
« Reply #4 on: Jul 7th, 2003, 9:46pm » |
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Least drastic is no meds.
Sherry
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TraceaTX
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Re: CH treatment flowchart
« Reply #5 on: Jul 7th, 2003, 9:58pm » |
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Ok Curtis, I am now @ #7 and am struggling with what to do next.
Since this past October I have been in the middle of CH hell. The cycle was broken once for 2 months after 11 days on DHE, Steroids, Indocin, Effexor, O2, Topamax, Seroquil and Imitrex (all oral abortives failed)...the headaches came back as bad...went thru 7 more days inpatient - this time no luck. Since March I have been in this current cycle. Dr. Mathew in Houston has now referred me to a Neurosurgeon for a Trigeminal Rhizotomy, however, after researching further I found some promising info on Trigeminal resection...hell, I have even tried Pot (no real help)...I am pretty desperate at this point. VERY depressed....I am currently on short-term disability because when I tried to go back to work I was there 3 hours and was hit hard.
Obviously I need some help....
TraceaTX 
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Ted
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Re: CH treatment flowchart
« Reply #6 on: Jul 7th, 2003, 10:07pm » |
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This person should probably check out the cluster survey results to the left and see what's been most effective for people there. I don't remember if it's broken down by what works best for chronics v. episodics, but I think it does.
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Not4Hire
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Re: CH treatment flowchart
« Reply #7 on: Jul 8th, 2003, 12:27am » |
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on Jul 7th, 2003, 6:32pm, Ueli wrote:I've heard that oxygen is a good abortive too, and cheaper than Imitrex.
Why isn't it in this flowchart? |
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I heard that too Ueli..... maybe the simplest and cheapest and least side effects and statistically most effective abortive....
(when it HURTS NOW... ya can SHOVE yer preventives....)
is left out of these deals.... well, i just hafta say: hmmmm...
Quote:| Suppose a person discovers they have CH. Assume this person has no experience with medications and no history of any other kind of condition. What should be the first measures this person takes, in terms of treatment modalities? |
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well, lets see... I got a pain in my ...o say....GROIN..... the first thing I should do is be .....o, say....CASTRATED..... then if that doesn't work .... mebbe .... put some Lamisil onnit....in case, it's just JOCK itch..... no, no..... I'll take some very expensive drugs that will make all the hair fall outta my shorts.... fill up my socks with TheDreadedGroinDandruff.... and then I'll consult a DOCTOR... or even a Chiropractor.... who will adjust my WALLET (hey, it's CLOSE to my GROIN.....) ....and then I'll .....
or maybe I'll just see if the Groin Problem is not .....just.....
my pants are too tight.... or I'm sufferin from DSB*.... or mebbe I need a BJ*.......or a HJ*.... mebbe I just need to take a step-fuckin-BACK .....and do the SIMPLEST thing FIRST.....
Quote:| Should treatment start with the least dramatic and get more drastic with each new approach? What is the least drastic approach? What is the most drastic approach? Should episodic sufferers be treated with a different approach than chronic sufferers? |
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Curtis...I sure hope that was a rhetorical question...... if not, I've gotten meself all excited over nuthin......
in any case....I hope somebody finds a cure.... meanwhile, remember what doctors are 'sposed to be taught:
FIRST, DO NO HARM......
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Pinkfloyd
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Re: CH treatment flowchart
« Reply #8 on: Jul 8th, 2003, 12:54am » |
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on Jul 7th, 2003, 10:07pm, Ted wrote:| This person should probably check out the cluster survey results to the left and see what's been most effective for people there. I don't remember if it's broken down by what works best for chronics v. episodics, but I think it does. |
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Good idea except the survey doesn't list any results for psilocybin/psilocin.....hmmm.....some might even say it's the most effective.....no?
Tracea, please consider the info found at www.clusterbusters.com before you schedule surgery. Ask Dr. Matthew or Dr. Hurt for their opinions...
research ALL your options.
PF
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CJohnson
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Re: CH treatment flowchart
« Reply #9 on: Jul 8th, 2003, 6:58am » |
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My list was not in any order of effectiveness. It was meant to clarify the type of question I was asking. Should the very first thing be Verapamil as prev. and oxygen and imitrex for abortives? If these aren't working, what do you try next? What do you do if that doesn't work? How many med combinations should be tried before resorting to surgery or narcotics?
It is well documented that everyone responds a little differently to different treatment modalities, but if a person has no history of taking any meds, or has detoxed and wishes to start from scratch, what is the logical step by step process of making sure you have done everything you could. You have to try something first, and if it doesn't work, you have to try something else, all the way down the line until you get relief, or have tried everything.
PFDANs
-Curtis
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