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Topic: Benzodiazepines and CH - do they help?? (Read 8901 times) |
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floridian
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Benzodiazepines and CH - do they help??
« on: Aug 27th, 2005, 10:51pm » |
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I remember reading a post not too long ago - one of the regulars here said their cluster activity went way down when they started taking xanax or one of the other benzo drugs for anxiety.
My first response was maybe a coincidence. My second response was that maybe it helps if a person has an anxiety problem, but isn't likely to help most people. Then today I read about research by (among others) Dr. Goadsby, and it said that benzo-drugs decrease the transmission of pain in the trigeminal nerve.
So any one else out there have experience with benzos affecting (or not affecting) their clusters?
More info at:
http://www.med-owl.com/clusterheadaches/tiki-index.php?page=Benzodiazepi ne+Drugs
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BikerBob
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Re: Benzodiazepines and CH - do they help??
« Reply #1 on: Aug 28th, 2005, 1:05am » |
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The benzodiazepines are a class of drugs with hypnotic, anxiolytic, anticonvulsant, amnestic and muscle relaxant properties. Benzodiazepines are often used for short-term relief of severe, disabling anxiety or insomnia. Long-term use can be problematic due to the development of tolerance and dependency. They are believed to act on the GABA receptor GABAA, the activation of which dampens higher neuronal activity. They began to be widely prescribed for stress-related ailments in the 1960s and 1970s.
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Benzodiazepines are commonly divided into three groups. Short-acting compounds act for less than six hours and have few residual effects if taken before bedtime, but rebound insomnia may occur and they might cause wake-time anxiety. Intermediate-acting compounds have an effect for 6-10 hours, may have mild residual effects but rebound insomnia is not common. Long-acting compounds have strong sedative effects that persist. Accumulation may occur.
The various benzodiazepines are listed in order of the shortest acting to the longest acting (by the approximate elimination half-life of the drug), however this time may greatly vary between persons.
* triazolam (Halcion®) - 2 hours
* midazolam (Versed®, Hypnovel®) - 3 hours (1.8-6 hours)
* oxazepam (Serax®) - 4-15 hours
* chlordiazepoxide (Librium®) - 5-25 hours
* alprazolam (Xanax®) - 6-12 hours
* temazepam (Restoril®) 8-20 hours
* lorazepam (Ativan®) 10-20 hours
* bromazepam (Lexotan®) 10-20 hours
* estazolam (ProSom®) 10-24 hours
* flunitrazepam (Rohypnol®) 18-26 hours. Withdrawn from the market in some countries; considered a "date-rape drug"
* clonazepam (Klonopin®, Rivotril®) 18-50 hours
* quazepam (Doral®) 25-100 hours
* clorazepate (Tranxene®) 36-100 hours
* medazepam (Nobrium®) 36-150 hours
* prazepam (Centrax®) 36-200 hours
* diazepam (Valium®) 36-200 hours
* flurazepam (Dalmane®) 40-250 hours
The following are not benzodiazepines, but have similar effects:
* zolpidem (Ambien®)
* zaleplon (Sonata®)
* meprobamate (Miltown®)
Uses
Benzodiazepines are used in many situations, depending on their pharmacokinetics. The main use of the short-acting benzodiazepines is in insomnia, while anxiety responds better to medium- to long-acting substances that will be required all day.
Midazolam is mostly used as an injection for sedation before surgical procedures.
Side-effects
Benzodiazepines have replaced the barbiturates because they have a lower abuse potential and relatively lower adverse reactions and interactions. Still, drowsiness, ataxia, confusion, vertigo, impaired judgement, and a number of other effects are common.
Benzodiazepines may impair the ability to drive vehicles and to operate machinery. The impairment is worsened by consumption of alcohol, because both act as central nervous system depressants. The effects of long-acting benzodiazepines can also linger over to the following day.
Abuse and dependence
Benzodiazepines induce physical dependence and are potentially addictive. An abrupt discontinuation of benzodiazepine input may result in convulsions, confusion, psychosis, or effects similar to delirium tremens.
Hence, every person on long-term or high dosage of any benzodiazepine should be carefully weaned off the drug.
Onset of the withdrawal syndrome might be delayed, and it might be delayed longer than the barbiturate withdrawal syndrome. Even when withdrawal from short-acting benzodiazepines often presents early.
The benzodiazepine withdrawal syndrome is characterized by:
* insomnia
* anxiety
* tremor
* perspiration
* loss of appetite
* delusions
Some of the withdrawal symptoms are identical to the symptoms for which the medication was originally prescribed. Benzodiazepines are valued by many patients for their ability to ameliorate existing conditions, while benzodiazepine dependency can cause them.
As it happens, benzodiazepines are the largest group of recreationally used drugs as well (Gerada & Ashforth 1997).
During the 1950s and 1960s, people doing benzodiazepine referred to it or a portion, usually a pill as "Bennie".
`
Intoxication
Benzodiazepine intoxication may lead to coma, but does not cause severe biochemical disturbances and therefore carries a relatively good prognosis. The antidote for all benzodiazepines is flumazenil (Annexate®), which is occasionally used empirically in patients presenting with unexplained loss of conciousness in emergency room setting.
Legal status
Flunitrazepam (Rohypnol®) is a Schedule I agent, and not commercially available in the United States.
History
The first benzodiazepine, chlordiazepoxide (Librium®) was discovered serendipitously in 1954 by the Austrian scientist Dr Leo Sternbach (1908-), working for the pharmaceutical company Hoffmann-La Roche. Initially, he discontinued his work on the compound Ro-5-0690, but he "rediscovered" it in 1957 when an assistant was cleaning up the laboratory. Although initially discouraged by his employer, Sternbach conducted further research that revealed the compound was a very effective tranquilizer.
http://en.wikipedia.org/wiki/Benzodiazepine
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karma
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Re: Benzodiazepines and CH - do they help??
« Reply #2 on: Aug 28th, 2005, 8:24am » |
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The last cycle for me was the first I tried any meds other than OTC pain meds. I gave a pred taper a try and Verap as well as zomig tabs. The result was a longer mores severe cycle than usual.
Coincidence? Who knows?
I do believe though that anxiety and tension during a hit increase the severity and length of individual hits which led me to try xanax after I trashed all the other stuff. I would pop one when I felt one coming on.
xanax helped me to relax, breath and get through a hit.
I don't have an anxiety problem and don't regularly take it but I will again next time.
I still got the hits but they were shorter and far less severe. I attributed that to being able to relax.
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Redd
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Re: Benzodiazepines and CH - do they help??
« Reply #3 on: Aug 29th, 2005, 5:24pm » |
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Flo,
I have a silly question...
Is Dr. Paul Goadsby related to the infamous Dr. Peter Goadsby? Or is there a typo on that page you have the link to?
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floridian
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Re: Benzodiazepines and CH - do they help??
« Reply #4 on: Aug 29th, 2005, 6:04pm » |
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on Aug 29th, 2005, 5:24pm, Redd715 wrote:Flo,
I have a silly question...
Is Dr. Paul Goadsby related to the infamous Dr. Peter Goadsby? Or is there a typo on that page you have the link to?
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Not a silly question - a silly typo on my part. 
The research team included one P.J. Goadsby, the prominent cluster headache researcher. Typo is now corrected on my page, thanks.
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Redd
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Re: Benzodiazepines and CH - do they help??
« Reply #5 on: Aug 29th, 2005, 6:27pm » |
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on Aug 29th, 2005, 6:04pm, floridian wrote:
Not a silly question - a silly typo on my part.
The research team included one P.J. Goadsby, the prominent cluster headache researcher. Typo is now corrected on my page, thanks. |
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oudista
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Re: Benzodiazepines and CH - do they help??
« Reply #6 on: Aug 30th, 2005, 10:42am » |
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I have just used Benzos as a short term remedy( 7 nights) for insomnia caused by too many nocturnal CH attacks, and I believe the relaxation helped a bit, but they are not very good for long term use, and sometimes they give me hangovers.
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E-Double
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Re: Benzodiazepines and CH - do they help??
« Reply #7 on: Aug 30th, 2005, 11:16am » |
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I think it was "plasticsoul" who used xanax regularly and found it to be the only thing helpful.
I'm with Karma. I used to use Xanax or the occasional valium when I just could not calm myself down.
These days I have a pretty good grip on not reaching the point of panic, though they sometimes do evoke it.
Any research regarding CH is appreciated!!!
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Lizzie2
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Re: Benzodiazepines and CH - do they help??
« Reply #8 on: Aug 30th, 2005, 5:38pm » |
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I take Ativan every night - used to be on Klonopin but it was a little too much for me. I take these for a different neuro trouble (RLS) - and they at least somewhat help for that, but I still can't sleep half the time - and they don't stop or decrease CH at all for me - a CH can still wake me straight up even after the benzo.
Ah well - live and learn.
Sometimes you have to take meds like this - I had to throw dependence and tolerance to the wayside because the other meds I tried for RLS did not help (Requip, Neurontin, etc). I have sort of a permanent mild form of extrapyramidal symptoms from taking phenothiazines and related meds - always for headache treatment - some IV, some oral, and some IM.
Geesh a major one they used to give me was thorazine - not only do phenothiazines send me into a weird cycle of SVT, but some (or most? not looking at the info right now) have anticholinergic properties - which, oddly enough, I had to take cogentin to fight the EPS from the phenothiazines - which is another anticholinergic - and it's drugs like this that sent me into anticholinergic toxicity to the point where I was unresponsive.
So - given the alternative, I take the benzos despite the warnings.
Doesn't make a difference for the CH at all, unfortunately!!
Carrie 
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floridian
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Re: Benzodiazepines and CH - do they help??
« Reply #9 on: Aug 30th, 2005, 8:52pm » |
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Blood levels of choline are low in clusterheads, which probably also limits acetylcholine production. I find it frickin amazing that this has been known for 20 years, yet no one has done any research on whether a choline supplement benefits us. Guess that comes with having a 'rare' disease.
http://www.med-owl.com/clusterheadaches/tiki-index.php?page=Choline
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E-Double
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Re: Benzodiazepines and CH - do they help??
« Reply #10 on: Aug 30th, 2005, 8:56pm » |
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Damn it Jonanthan........
You are gonna be the lone man who discovers the cure.
Truly amazing brother!
Thank you,
Eric
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I can't believe that I have to bang my
Head against this wall again
But the blows they have just a little more
Space in-between them
Gonna take a breath and try again.
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Lizzie2
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Re: Benzodiazepines and CH - do they help??
« Reply #11 on: Aug 30th, 2005, 9:18pm » |
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OK Jonathan...why don't they figure this stuff out? Sheeeeeeesh......
I guess this could explain why a dose of anticholinergic meds that would be okay for a normal person might completely cause a toxicity that was very dangerous (not that I remember any of it....just bits and pieces...)
Then...honestly pardon that I can't remember things well at the moment... would there be a problem with inflammation with lower or higher levels of choline?
I dont' drink coffee or smoke so in the meantime....maybe I should get a supplement. Choline might actually help a LOT of my problems.
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nani
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Re: Benzodiazepines and CH - do they help??
« Reply #12 on: Aug 30th, 2005, 9:46pm » |
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on Aug 30th, 2005, 8:56pm, E-Double wrote:
Yes, you are!! Thanks, bro.
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Lizzie2
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Re: Benzodiazepines and CH - do they help??
« Reply #13 on: Aug 31st, 2005, 12:34am » |
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Jonathan -
Some additional thoughts/questions. Honestly, I've been looking for some 'connection' between all the health problems I've run into (especially because I'm awfully young for such a long list of medical trainwrecks!), and this low choline theory could potentially connect a few of them together. Once I get a very accurate but concise summary of my own medical history/current problems, I'm wondering if you would mind taking a look at it (when you have the time) and you and I could put our collective research minds together and see what pieces of the puzzle we can fill in? Of course, there would be no rush as I know you are busy with the wonderful work you've been doing! It was just a thought...
In the meantime, do you have any diagram, description, etc as a resource on the choline, acetylcholine, etc pathway? Also things that branch off that pathway, especially relating to the inflammatory process? I'm picking up on these as something relevent to a few of the things I've run up into in my own life.
How do they measure choline levels? Or rather I should rephrase - what set of blood labs would reveal this problem the most accurately? Unless I slept through this lecture, there is still no test to determine the amounts of acetylcholine, serotonin, and other neurotransmitters though, is that right?
I keep coming back to the idea now that it seems logical that I can suffer anticholinergic toxicity so much more quickly than a normal person - as this toxicity is generally rare in young people taking medication as directed. However, it would be interesting to note that the anticholinergic problems and some other possibly related problems did not come to light until the last year or so... I'd been taking these same meds in the hospital for quite a few inpatient stays, but I didn't have CH then and although I had some pretty strong side effects (especially to the phenothiazines) - I never had the Anticholinergic toxicity until fairly recently. So perhaps it wasn't an issue until I developed the CH instead of just when I had the NDPH/chronic migraine alone.
What are the PLC enzymes that you wrote about in one of the last 2 paragraphs of your page on choline? How do cholinesterases relate? (Or maybe they don't relate at all - but I'm just drawing in a similar sounding word in the wrong place!)
Do you feel that taking a choline supplement may be a worthy/potentially helpful thing to try? I'd be willing to at least look into this - but preferably with caution and in a safe manner since I am so extremely sensitive to playing with certain chemicals - obviously anticholinergics, but also meds that affect dopamine receptors (such as droperidol (or reglan?) one of those!) I am banking on the fact that biological chemicals are out of balance in my body which is leading to several other problems! (Obviously not saying that my CH is caused by this, but I do think it has the potential to definitely play some role!)
Do you have any sort of list or reference as to any other conditions where patients have been found to have lower than normal choline levels?
Also, I know you mention coffee and nicotine definitely having a role in choline - (Does ACH bind to muscarinic or nicotinic? Wish I remembered all of this!) - I noted that you wrote that there isn't any evidence that a choline supplement would have a benefit for CH - what other sources of choline exist? Because I don't drink coffee, I'd have to find some other source - I'm wondering if it is similar to some other supplements in that a synthetic form may have far less of a desired effect than the same chemical found in its natural form - not extracted from this form. Do you know if that's the case? I would hate to take a choline supplement futilely if it weren't going to act properly being due to an extract of sorts!
Sorry I have so many questions!! I really am curious about this... Thanks in advance for answering even a few of the questions here when you have time!
Take care,
Carrie
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Lizzie2
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Re: Benzodiazepines and CH - do they help??
« Reply #14 on: Aug 31st, 2005, 12:39am » |
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Oh one other big question that I forgot to ask. When I had the first anticholinergic toxicity reaction, the neurologists (attending/residents) stopped depacon and slowly weaned off the cogentin - but I later had to take the cogentin again, just at half the dose I'd been at (1mg as opposed to 2mg).
So, if I'm reading this all correctly and lithium supposedly raises the levels of choline to a very high level, and we know lithium is beneficial to many CH'ers - what's the explanation for depacon (or it's basically chemically similar sister - depakote), which have also been named helpful in treating CH by several sources. It would seem to me that depacon has the ability to work in an anticholinergic way but lithium does the opposite. Is there an explanation for why such opposing processes would both be named beneficial for CH prevention?
Just curious! Thanks again!!!
Carrie
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