Clusterheadaches.com Message Board


    
      
        Clusterheadaches.com Message Board
        (http://www.clusterheadaches.com/cgi-bin/yabb/YaBB.cgi)
      

        New Message Board Archives >> 2005 Cluster Headache Specific Posts >> definition of rebound headaches?
        
(Message started by: debs on Feb 3^rd, 2005, 12:45am)

Title: definition of rebound headaches?
Post by debs on Feb 3^rd, 2005, 12:45am

I'm curious as to what rebound headaches from imitrex are --Do you mean that you get another CH, or you end up with some other non CH headache?

I have had headaches (not CH) from using vicodin for toothaches, but I am not sure if this is what is meant by rebound.

I ask because of my experience with imitrex injections last night. I didn't want to take the whole 6 mg dose for my 1st try, and so divided the 6 mg -lost ~1/3rd in the process... I woke up first at 2:30am, used ~2mg imitrex, some relief after about 15 minutes. Then 2 more HAs at 2 hr intervals. HA#2: 2mg imitrex again. For HA #3, I just popped a new vial out of the cartridge and used a q-tip to inject ~3 mg, no time to transfer to a syringe. This worked, and I haven't had an HA since, good thing since I had almost reached the daily triptan limit.

I'm wondering if HA#'s 2 and 3 could have been rebound, or if I didn't use enough drug for HA 1 and 2... My doc said I need to use the full dose for the drug to be effective, but I still don't feel comfy with that, I really hated the rush and tightness, but the relief was pretty fast.

Anyway, I forgot to ask my doc today about the possibility of rebound, I was a little frazzled.

btw, I did use the o2, but the rate was only 8L/m and I didn't do a very good job of taping the holes in the mask. I feel a little claustrophobic in the mask... Sucking straight from the tube worked better, but i have no way to know if it worked on my head since i used the imitrex too. I am way too chicken to try the o2 by itself in case it doesn't work.

my best to your head,
Debbie

Title: Re: definition of rebound headaches?
Post by Frank_W on Feb 3^rd, 2005, 8:36am

Hi, Debbie. Rebounds are cluster headaches, and there is also the "Imitrex Hangover," which I've experienced. Last cycle, I was having a real monster of a cluster headache, so I used an auto-injector shot of Imitrex. Holy cow!! Every drop of blood in my body seemed to be racing for my head... It knocked out the cluster headache, but the next day, I shadowed hard all morning. In the eight years that I've had cluster headaches, I never experienced shadows until using Imitrex. In years previous, my cycle was 6-8 weeks long. This last cycle, using Imitrex and Verapamil, my cycle ended up being 13 weeks long.

Your mileage may vary. These are my results.

Best wishes and PFDAN,
-Frank

Title: Re: definition of rebound headaches?
Post by nani on Feb 3^rd, 2005, 8:43am

Deb...Frank is right about rebound cluster headaches as a result of CH meds, but they can occur with any type of headache as a result of overusing medication. Look here for more info:

http://headaches.about.com/cs/medicationsusage/a/rebound.htm

Title: Re: definition of rebound headaches?
Post by JJA on Feb 3^rd, 2005, 9:18am

I believe, technically, in the medical community, a rebound headache is a hangover type headache, not CH. However, a cluster headache recurrence is a common "rebound" (or withdrawal) type of reaction. So, on this CH-driven board a rebound headache means a cluster headache. (Ch-ers never complain about regular headaches... I kinda enjoy them.)

I would say that your headaches were "rebound" to the clusterhead community, but don't tell your neurologist...

Jesse

Title: Re: definition of rebound headaches?
Post by floridian on Feb 3^rd, 2005, 10:08am

I don't think there is one single, standardized idea of 'rebound' headache - could be from short term overuse, longer use & withdrawl, or longer continuous use. Here is one abstract that uses the term "medication overuse headache" and "analgesic rebound" to describe headaches that arise from long term use of triptans (or other meds like barbituates, d.n.a.) . They list several possible mechanisms that may be at work (strangely, the authors seem to think that only migraneurs are susceptible!).

Quote:

Drugs. 2004;64(22):2503-14.

Medication overuse headache from antimigraine therapy: clinical features, pathogenesis and management.

Smith TR, Stoneman J. Ryan Headache Center, Mercy Health Research, St Louis, Missouri 63017, USA.

Medication overuse headache (MOH) is being recognised more often in headache, neurology and primary care clinics, but is still frequently overlooked. The most significant factor in the development of MOH is the lack of widespread awareness and understanding on the part of clinicians and patients. While the diagnosis of MOH may be suspected clinically, it can only be confirmed in retrospect. Diagnosis may take > or =3 months because of the need for prolonged observation after cessation of medication. Diagnosis must be based on observation of patterns of headaches and medication use, remembering that MOH is only seen in patients with migraine and not in those without. MOH should be viewed as an entity that is caused or propagated by frequently used medication taken for headache symptomatic relief. Because of easy availability and low expense, the greatest problem appears to be associated with barbiturate-containing combination analgesics and over-the-counter caffeine-containing combination analgesics. Even though triptan overuse headache is not encountered with great frequency, all triptans should be considered potential inducers of MOH. There are several different theories regarding the aetiology of MOH, including: (i) central sensitisation from repetitive activation of nociceptive pathways; (ii) a direct effect of the medication on the capacity of the brain to inhibit pain; (iii) a decrease in blood serotonin due to repetitive medication administration with attendant upregulation of serotonin receptors; (iv) cellular adaptation in the brain; and (v) changes in the periaqueductal grey matter. The principal approach to management of MOH is built around cessation of overused medication. Without discontinuation of the offending medication, improvement is almost impossible to attain. A three-step approach to treating patients with analgesic rebound headaches includes: (i) a bridging or transition programme; (ii) nonpharmacological measures; and (iii) prophylactic medication started early in the course of treatment (after offending medication is successfully discontinued). The best management advice is to raise awareness and strive for prevention. Prophylactic medications should be initiated for patients having > or =2 headache days per week. Anticipatory medication use should be discouraged and migraine-specific therapy should be considered as early as possible in the natural history of patients' headaches. Reduction in headache risk factors should include behavioural modification approaches to headache control earlier in the natural history of migraine.

Title: Re: definition of rebound headaches?
Post by debs on Feb 3^rd, 2005, 8:18pm

Thanks everyone for the info.

It was my impression that rebound headaches were more of the garden variety type (and yeah, I never minded those either after CH), and figured I could handle those. But... CH is so different, and no one wants an extra CH.

I agree that seems strange that rebounds would only affect migraneurs, maybe HA patients are more prone to reporting HAs in general...

Quote:

A three-step approach to treating patients with analgesic rebound headaches includes: (i) a bridging or transition programme; (ii) nonpharmacological measures; and (iii) prophylactic medication started early in the course of treatment (after offending medication is successfully discontinued).

ok, so now we need a transitional med to help us get off our abort med that we use while we wait for our rebound prevent med to kick in, while still waiting for our CH prevent med... !!!! :-/

Had the same experience this morning: 3 headaches, 3 injections, 2-4 hrs intervals. Getting a little braver and using more drug, but this is only day 2 of using imitrex for me. Today -I'm just wiped out, I think fatigue is a side effect?

Sooo... how would you tell if you were coming to the peak of a cycle rather than having rebound HAs from imitrex use?

Title: Re: definition of rebound headaches?
Post by Bob P on Feb 4^th, 2005, 9:40am

Here ya go. The 2nd article is about using Imitrex to bridge the gap of detoxing from rebounds

http://www.clusterheadaches.org/library/medications/imitrex_rebound.htm

Title: Re: definition of rebound headaches?
Post by JJA on Feb 4^th, 2005, 9:54am

on 02/03/05 at 20:18:41, debs wrote:

Sooo... how would you tell if you were coming to the peak of a cycle rather than having rebound HAs from imitrex use?

You might not like the answer...stop using trex. Some things are better left a mystery.

Jesse

Title: Re: definition of rebound headaches?
Post by debs on Feb 5^th, 2005, 3:58am

Thanks for the links all, very helpful.

Perhaps rebound HA is a recurrence of whatever type of HA that one has??? seems so

It also seems the opinion is mixed here with respect to meds prolonging a cycle or not. I know, at least for me, using meds makes it a little more manageable, with longer pain free times, and making me more functional. Never really had decent treatment, or pain free times in previous cycles... triptans didn't exist --they are a miracle drug. I just can't take the pain, I will take the trex shot every time, even if it makes the cycle longer, at least for now... yes the mystery...

Yeah, my neuro says its the nature of the cluster, probably not rebound from trex. Could be, these particuar guys see a lot from their side of the HA biz. He also said that the fatigue is probably a result of the clusters, not the trex: "you're really going thru a lot right now." "oh yeah! that's right! I am!" so nice to be understood by the doc, very different experience from past cycles.

But---this morning I aborted an attack with O2!!!! in 7 minutes!!! I was thrilled, made my day. No $70 shot, no side effects. The key, for me, is catching it in time,won't work if I get a hit while asleep... but now I have proof that O2 works for me, at least for now. Will carry it everywhere from now on.

best, and PF,
Deb