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        Cluster Headache Help and Support >> Cluster Headache Specific >> Atrial fib and Imitrex
        
(Message started by: kk on Mar 7^th, 2007, 6:31pm)

Title: Atrial fib and Imitrex
Post by kk on Mar 7^th, 2007, 6:31pm

I’m posting this to get your advice; I value your comments more than any doctor. It’s been two years since my last post and two years since my last Cluster HA.

I was just diagnosed with atrial fibrillation, however I’ve been dealing with it for several years. My doc is experimenting with different meds (Rythmol, Flecainide) trying to get it under control but we haven’t found the magic pill yet. I feel like crap now because of losing sleep due to irregular heart rhythms, I’m assuming is due to the meds. Now all of a sudden the ‘beast’ is back as of last night. I used O2 and knocked it cold but I’m heading out of town this weekend and can’t bring the O2 on the plane.

I mentioned to my doc (today) that I’ll probably have to take a shot of Imitrex and he freaked. After questioning him on his experience with cluster headaches it was apparent he didn’t know much about them. I said, “I’ve got a gun in one hand and a shot in the other, which one do I use?” He said don’t take the Imitrex.

What’s your advice fellow CH sufferers?

Title: Re: Atrial fib and Imitrex
Post by envirodefender on Mar 7^th, 2007, 6:55pm

I was recently told that there is a connection with a small hole being present in the heart that apperantly has some connection with migraines, and if it can be closed then it should/could help the attacks. It's still anecdotal, at best, and they are not sure if there is any connection to CH.

On the other hand, I had a Cardiac Chath. Oblastion in Jan. of '06 that the brain trust said would "cure me" of the migraines and CH. It cured the SVT (which was the heart problem I was having) but did squat for anything else.
My concern is the two drugs you mentioned for your are dangerous with the Imitrex. It can cause a spike in blood pressure and tightness in your chest.
Is there any way you can talk to or see another Dr. before you fly?
It's a bit dodgy to mess around with cardiac stuff. Sorry to say, I'd probably listen to your Dr. and see if there is something else he suggests.

Title: Re: Atrial fib and Imitrex
Post by UN solved on Mar 7^th, 2007, 8:09pm

I wouldn't use it unless it was a last resort, and then I would use only 2 or 3 mg at most.

Goodluck

UNsolved

PS. Your doc is still going to prescribe Imitrex for you ?

Title: Re: Atrial fib and Imitrex
Post by kk on Mar 7^th, 2007, 8:21pm

Different doc and I hoard that stuff when not in a cycle. I’ve got about 2 gallons dating back several years.

Title: Re: Atrial fib and Imitrex
Post by Gator on Mar 7^th, 2007, 9:27pm

Maybe you could talk to your doctor about Zyprexa (olanzapine). It has been successfully used as an abortive for people with heart conditions. Several people here use it and swear by it.

Quote:

1: Headache 2001 Sep;41(8):813-6

Olanzapine as an Abortive Agent for Cluster Headache.

Rozen TD.

Department of Neurology, Jefferson Headache Center/Thomas Jefferson University Hospital, Philadelphia, Pa.

OBJECTIVE: To evaluate olanzapine as a cluster headache abortive agent in an open-label trial. BACKGROUND: Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs. METHODS: Olanzapine was given as an abortive agent to five patients with cluster headache in an open-label trial. The initial olanzapine dose was 5 mg, and the dose was increased to 10 mg if there was no pain relief. The dosage was decreased to 2.5 mg if the 5-mg dose was effective but caused adverse effects. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose. RESULTS: Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and two patients became headache-free after taking the drug. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness. CONCLUSIONS: Olanzapine appears to be a good abortive agent for cluster headache. It alleviates pain quickly and has a consistent response across multiple treated attacks. It appears to work in both episodic and chronic cluster headache.

Title: Re: Atrial fib and Imitrex
Post by E-Double on Mar 7^th, 2007, 9:49pm

I swear by it!!!!!!!!!!!!

Title: Re: Atrial fib and Imitrex
Post by chrisw on Mar 8^th, 2007, 4:13pm

try the imitrex tip listed on this site, if you feel you need to use trex. It really does work with just half a shot. the only difference i can detect, is maybe 30seconds longer to kick in. I know that seems like forever, but I never feel that racing heart and tightness in my chest anymore when I only use the half a dose, the othere thing that I would recommment is getting it all ready to use(peel back the labe l on the vial, loosen the vials get a qtip and store it in the stat dose box.) before you need it, because during a bad one, there is no way anyone with a true cluster could handle doing those things. I know iI cant, its too intricate, and I can hardly see during one.

chrisw

Title: Re: Atrial fib and Imitrex
Post by kk on Mar 8^th, 2007, 5:27pm

Thanks everyone. I’ve been getting my Trex in the little vials with the rubber top and using insulin needles to draw about 15 units (2mg). That has been working great and I don’t feel the ‘shock’ like I did with the full dose. However, after seeing the expression on my cardiologists face he kind of scared the sh__ out of me.

I will look into olanzapine as well. It’s hard to believe anything taken orally will work as fast as Imitrex but I’ll give it a try.

Thanks again for all your comments.

Title: Re: Atrial fib and Imitrex
Post by kk on Mar 13^th, 2007, 1:58pm

After sucking 1500 PSI of oxygen last night I opted for the Imitrex to try and abort a KIP 8. I don’t think I want to try that again. I thought my heart was going to jump out of my chest. I only did 2mg and it didn’t get rid of the headache. Normally I would do another 2mg but I didn’t want to risk it so I went back on the O2 for another ½ hour before it finally subsided. What a night!!!

Tell me more about Olanzapine…..please. Does it take long to start working? How does it compare to Imitrex? Are there any side effects?

Title: Re: Atrial fib and Imitrex
Post by Gator on Mar 13^th, 2007, 5:26pm

Olanzapine aka Zyprexa is an atypical anti-psychotic medication used in the treatment of schitzophrenia and manic depressive disorder. It has also been found to be an effective abortive for ch for some patients with heart conditions who cannot take triptans.

Several people here either use it or have tried it.

E-Double says it will abort for him a fast as imitrex without any of the bad feelings he gets from triptans.

I have used it and it takes a little longer for me, but it has worked. I usually keep it on hand for days when I have gone over the limit for trex or am someplace I can't carry oxygen or use an injection.

The main side effect is sleepiness, however you do need to research the med more extensively to view the full list of side effects and possible interactions with any medications you are currently taking. You will need to talk to your doctor about taking this as it is available by prescription only.

It is another tool in the arsenal.

Title: Re: Atrial fib and Imitrex
Post by Rosybabe on Mar 13^th, 2007, 5:34pm

here is a link...

http://www.drugs.com/zyprexa.html

Title: Re: Atrial fib and Imitrex
Post by kk on Mar 13^th, 2007, 5:37pm

Thanks for the info, I'll call my neurologist tomorrow. For the time being, I'm going off the heart meds so I can take the trex per my cardiologist’s recommendation.

Title: Re: Atrial fib and Imitrex
Post by Gator on Mar 13^th, 2007, 5:48pm

Now I am confused. In no particular order:

1. If you have a heart condition, why are you coming off the heart meds?

2. If trex was such a negative experience with the heart meds there to intercede, won't the trex be worse without them?

3. Why would a doctor allow a person with a heart condition to have trex in the first place?

4. What is the airspeed velocity of an unladened swallow?

Title: Re: Atrial fib and Imitrex
Post by kk on Mar 13^th, 2007, 6:09pm

1. If you have a heart condition, why are you coming off the heart meds?

My heart is fine, it just has an ignition problem. I have had atrial fib for at least 4 years but just recently diagnosed. The cardioligist said it would be better for me to go off the Flecainide if I really need to take the Imitrex since I've been dealing with this for so long already. He just doesn't think my heart can take another 20 years of arythmia.

2. If trex was such a negative experience with the heart meds there to intercede, won't the trex be worse without them?

Doc say it should be out of my system by the time I need another shot.

3. Why would a doctor allow a person with a heart condition to have trex in the first place?

I guess that depends on what the heart condition is.

4. What is the airspeed velocity of an unladened swallow?

"...estimate that the average cruising airspeed velocity of an unladen European Swallow is roughly 11 meters per second, or 24 miles an hour."

Title: Re: Atrial fib and Imitrex
Post by Gator on Mar 13^th, 2007, 8:26pm

Still confused. I'm not a doctor and don't know your particulars. Your doctor obviously has his reasons for taking you off the Flecainide. Nonetheless,

1. There are no known interactions between the two drugs, at least none that are listed on the interactions matrix at drugdigest.org. If you don't need it, that's cool. If you are just coming off because of taking trex, I don't understand, not that I really need to when it is all said and done. Treatment choices are and should be between you and your doctor.

2. BUT, it would appear that since the Flecainide controls heart rhythm and tachycardia, it might be a good thing for you to have in your system if you are going to take trex.

3. If trex would not cause the atrial fib to worsen and damage your heart, then what the hell, but...While it is rare, imitrex has been known to cause Atrial Fib, which would lead a layman such as myself to conclude that it would 1. be potentially dangerous in patients who already had that condition and 2. a medication that helped control heart rate and arrhythmias might be a good thing while taking trex.

I'm really not trying to go out my way to be difficult or thick here. I just like for A + B = C and that doesn't seem to be happening here. Maybe I should mix me up another sleep cocktail and re-read after I have had some sleep.

4. Yes, but is that the African or the European swallow? ;;D

Title: Re: Atrial fib and Imitrex
Post by kk on Mar 13^th, 2007, 8:58pm

All good points and I appreciate your input and research. I have done the same and I’m as confused as hell. I called both doctors and was left as confused as before I called them.

Cardiologist say’s, “I don’t know much about Cluster headaches but would rather you not take Imitrex with the Flecainide. If you must take Imitrex, stop taking the Flecainide. You’ve been living with the arythmia this long, it won’t hurt you to go a few more weeks without it.”

Neurologist say’s, “Don’t worry, the drugs don’t interact.”

I say, “I don’t know what the hell to do?”

I’ve been on the Flecainide for about a week and it isn’t really doing a good job at controlling the arythmia. Last night’s headache reminded me how bad these bastards can get. This is only my 1st week in a new cycle so you tend to forget how bad they are.

Duh….I just put 2+2 together….maybe this shit started my cycle?

What is a sleep cocktail?

4. European I'm sure ;)

Title: Re: Atrial fib and Imitrex
Post by BB on Mar 14^th, 2007, 2:30am

on 03/13/07 at 20:58:12, kk wrote:

Cardiologist say’s, “I don’t know much about Cluster headaches but would rather you not take Imitrex with the Flecainide. If you must take Imitrex, stop taking the Flecainide. You’ve been living with the arythmia this long, it won’t hurt you to go a few more weeks without it.”

Neurologist say’s, “Don’t worry, the drugs don’t interact.”

I say, “I don’t know what the hell to do?”

Sounds typical to me ! Specialists are so specialised into their own field that they dont know anything else. Quite often if they think the other condition is worse and need to be treated first they will withdraw their prescription to avoid being blamed and then sued if something bad happens. I can see that the cardiologist's reasoning that since you had this AF for years without meds then going off meds now shouldnt make things worse, while possibly allowing for the trex to work better. The neurologist on the other hand just needs to make sure that the cardiologist is happy that you will not keel over from the heart soon.

There are 2 things that you can do to make it clearer/better for yourself. 1- If you have a good GP, go talk to him about the condition and medication, the GP can communicate more effectively with both specialists to work out what is the best thing to do. 2- You can educate yourself more about the condition and the meds plus educate your cardiologist about CH. Its good to do this anyway.

Do you know what type of AF you have? Do you get any physical symptoms with it? Like chest pain? palpitation? tiredness? anxiety? short of breath? etc ... Has it gotten worse compared to before? If you had dealt with it for years in the past without med is there any reason you need to take meds now?

Do ask about Zyprexa, it does work quite well for some and it doesnt affect the heart nor the blood vessels like Trex does. Regarding oxygen, you can request it on the plane and there are portable tanks.

Take care and painfree wishes to you.

Annette

Title: Re: Atrial fib and Imitrex
Post by kk on Mar 18^th, 2007, 9:30am

Quote:

Do you know what type of AF you have? Do you get any physical symptoms with it? Like chest pain? palpitation? tiredness? anxiety? short of breath? etc ... Has it gotten worse compared to before? If you had dealt with it for years in the past without med is there any reason you need to take meds now?

I'm not sure what you mean by "what type" but I do not have any symptoms other than random periods of palpitations. I stopped taking the meds as my HA's are getting worse and O2 only takes care of about 20%. I tried Red Bull the last two nights with no luck. Imitrex works great and without the anti-fib meds, I'm having no side effects. In fact, I feel a lot better off the anti-fib meds. I'm having very few palpitations now.

I started getting AF after the hurricanes in '04. My home was damaged and work was destroyed. I'm wondering now if the doc was premature and this was nothing more than temporary stress.

Title: Re: Atrial fib and Imitrex
Post by brian trudeau on Mar 20^th, 2007, 5:48am

At the end of my last cycle last November (and it was a doozy) I was told I have a rare form of cardiomyopethy called arrythmagentic right ventricle dysplasia (ARVD) they found it back around Thanksgiving when they wanted to up my dose of verapamil and I told them that I was having palpitations on it so they ordered a EKG to see what was going on since the verapamil should be controling heartbeats instead of throwing it out of beat. Test showed i was throwing PVC's every other beat so after a holter monitor, echocardiogram, and a cardiac MRI they found that my right ventrcile is slowly turning from normal heart muscles into a fatty/ scar tissue. I recently had a EP Study done to see if I needed a defibulator put in yet and luckily I do not at this time. Wondering how my next cycle will cause the heart to react. Sometimes I think it was all the meds that caused this problem with the heart but cardiologist says it is a rare form of a genetic link. Maybe there is some connection between the heart and headaches. As for now I am off all the meds except for a beta blocker (Toprol) when and if the next cycle hits my neuro said we may just need to stick with O2 from here on out not to progress the heart condition since most meds might have some side effects involving the heart. Anyone else with CH's have heart conditons?
wishing all pfdan,
Brian

Title: Re: Atrial fib and Imitrex
Post by ClusterChuck on Mar 20^th, 2007, 6:48am

I have had several minor heart attacks, and have three stents in place.

I am still able to take verapamil. I am presently on neurontin. My neuro refuses to give me a script for imitrex, although I have taken it, since my heart problems, thanks to friends. She is mostly afraid of getting sued.

Svenn has had a heart attack, and he takes a LOT of trex, without any problems.

I guess it comes down to what specific problem you have with your heart.

All of my problems have been due to high cholesterol, not a weak heart.

I have been hit a few times while flying. Twice I was allowed to use the plane's portable O₂ to abort, without any question, or extra cost. I had not set up any preflight notification with the airlines. I say I only used the airlines O₂ twice. That does not mean I was refused the other times. I just rode out the others, as they were not that high a KIP level.

Good luck!!!

Chuck

Title: Re: Atrial fib and Imitrex
Post by BB on Mar 20^th, 2007, 5:31pm

There are many subtypes of atrial fibrillation and many causes as well. Take a look at this article for a start

http://jtcs.ctsnetjournals.org/cgi/content/full/126/6/1686

There are paroxysmal AF, chronic AF, intermitten AF and persistent/permanent AF to name a few. There are also many causes from nerve conduction problems to valve problems to cardiac muscular myopathy etc. There is also atrial flutter which is often misdiagnosed as atrial fibrillation.

Therefore it is very important to sort out which one you have and the exact cause. You will need an ECG ( electrocardiogram ) and cardiac ultrasound to check the valves and the muscles and possibly an angiography to check the patency of the arteries/veins before a proper diagnosis is made.

If you didnt have a history of heart problem, dont have a family history of heart problem and dont have other risk factors such as smoking and high cholesterol, plus you developed heart palpitation only intermittenly and only at times of stress then maybe you dont have real AF with a cardiac risk. In that case, imitrex would be OK for you to use ( strictly as directed though). However, you cant be sure until the heart specialist has done all the tests and give you the all clear.

Zyprexa works well and doesnt affect the heart but long term use and frequent use can increase the risk of diabetes so you need to consider your own history to see if you have higher risk of this condition.

My husband used Zyprexa as well as Imitrex. Imitrex injection takes 2-3 mins to work for him and Zyprexa takes 7-15 mins. He also found that Imitrex "switches off" the drilling behind the eye very abruptly and fully while Zyprexa reduces it down slowly bit by bit. However, Zyprexa doesnt leave a 'washed out" feeling like Imitrex.

I hope that helps. Painfree wishes to you.

Annette

Title: Re: Atrial fib and Imitrex
Post by Gator on Mar 20^th, 2007, 5:44pm

on 03/18/07 at 09:30:29, kk wrote:

I'm not saying you should ignore the possibility that you do have a physical condition. I would think with all the tests and such, your doctor would know the difference, but considering your last statement, you may want to do some research on Panic Attacks, Panic Disorder, Generalized Anxiety Disorder and Post Traumatic Stress Disorder.

I know from first hand experience that Panic Attacks can make you feel like you are having a heart attack. Chest pain, palpitations, sweating, shortness of breath are all symptoms of a panic attack. When you have panic attacks combined with a fear of more attacks and/or the implications/consequences of more attacks for more than a month, it is often diagnosed as Panic Disorder.

Here is a link to the Psych Central page on Panic Disorder.

http://psychcentral.com/disorders/sx28.htm

I don't remember your particulars. Just out of curiosity, how long have you had CH? Did onset coincide with the hurricane as well? The reason I ask is there have been cases where the onset of CH was brought about by extreme emotional stress.

http://jnnp.bmj.com/cgi/content/extract/77/9/1097-a

Quote:

Onset of cluster headache triggered by emotional effect: a case report

P S Sandor1, P Irimia1, H R Jager2, P J Goadsby3 and H Kaube3

Cluster headache is a strictly unilateral headache that occurs in association with autonomic symptoms. Stress is a recognised precipitant of migraines, but not of cluster attacks. We describe the case of a patient having migraine for years, in whom extreme emotional stress triggered cluster headache attacks.

Just something to chew on.

Title: Re: Atrial fib and Imitrex
Post by kk on Mar 21^st, 2007, 7:14pm

Wow! After reading the other posts it makes my issues seem trivial. I’ve had CH’s since I was 17, that was 32 years ago and I’ve been on all the preventive meds. The only thing that seems to work is abortive measures while riding out the monster.

The panic attack symptoms are VERY close to what I was experiencing however; I had them 3 to 5 times a day. Sometimes they lasted over 30 minutes. (Thanks for that information). I’ve been off the AF drugs now for 2 weeks and have had very few ‘episodes’ since stopping the meds.

I have always been very active and proud of my stamina and condition, playing racquetball, racing motocross, and jumping big waves on a stand-up jet ski. Out of the blue I get these arrhythmias and head to the doc where I was diagnosed with moderate MVP. The cardiologist says it’s not bad, stay on the Lopressor prescribed by the walk-in clinic doc, and see ya in two years.

Fast-forward three years and the ECG shows no change in my heart structure. He is ready to send me on my way until he listens to my heart. “Do you feel that?” he says. (I just happened to be going through one of my episodes) “Yeah, I get them all the time.” He says, “You have AF and we need to get this under control before you wear out your heart. Try these other AF meds.” Here’s the good part…..”They will either help or make your condition worse.” They did the latter.

Zyprexa sounds like another arsenal I should add to my medicine chest. What is considered ‘frequent use’ to avoid diabetes? Do you take them as soon as you feel an onset? After 32 years of these bastards, I can usually tell when I'm going to get a CH hours before they hit. I've tried O2 and Imitrex when I get the symptoms but if I don't wait until I feel the pain, it's usually a waste.