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        Cluster Headache Help and Support >> Cluster Headache Specific >> Imitrex dependence?  Need input!
        
(Message started by: heatherk on Nov 24^th, 2007, 8:04pm)

Title: Imitrex dependence? Need input!
Post by heatherk on Nov 24^th, 2007, 8:04pm

Hi, everyone-

I have been on this site every few years whenever I get into a cycle. I've been a sufferer for about 17 years, pretty much like clockwork every 1 and a half to 2 years were my cycles, lasting about 3 weeks. When I was pregnant with my 3rd and 4th kids, I went into cycles about halfway through each pregnancy (which were awful since I couldn't do ANY treatments except for O2!). But other than those aberrations, I have been very regular, so to speak. Here is my problem: I just finished a VERY bad cycle--extreme pain for much longer than usual--more in the neighborhood of 5 or 6 weeks instead of the typical 3-4. I also had to do the following to really wipe out the headache: Imitrex nasal spray, Maxalt dissovlable tablet and then 2 Vicodin. It was only these 3 in conjunction that really wiped out the headaches this time, esp when they were at their worst. Anyhow, the cycle has almost ended but it is a little unusual this time. I usually have intense headaches that go on and on for weeks and then they lessen in intensity and severity and taper of a bit and then completely disappear. This time, though, I did have the taper, but now I seem to be stuck in this rut where every day, twice a day (upon waking and early evening, just like the bad clusters were occurring at the end of this cycle) I get really bad headaches that are basically regular migraines and are only alleviated by taking an Imitrex 100 mg tablet, in which case they are completely eradicated. This last phase has gone on for about 2 weeks, and it is just so unusual that I have the whole thing hanging on this long. Aside from being paranoid that I am becoming chronic instead of episodic (!), I am wondering if my body has just become acclimmated to getting a hit of a triptan twice a day, and that the regular migraine is like a withdrawal symptom being expressed. Has anyone had this happen or heard of it happening? Or am I just dealing with a cycle that is hanging on for some reason but will do this sudden-disappearance thing eventually? I don't know if I can keep going like this--my life has been unbearable this whole past month and a half. Any advice would be much appreciated. Thanks in advance...

Heather in NYC

Title: Re: Imitrex dependence? Need input!
Post by brewcrew on Nov 24^th, 2007, 9:49pm

Hi, Heather - I didn't read your entire thing because my eyes can't handle long things without paragraph breaks. I did, however, see that you're taking maxalt right after imitrex. Unless you have specific clearance from your doctor, you should not mix triptans. Very dangerous - heart attack waiting to happen.

Title: Re: Imitrex dependence? Need input!
Post by Kevin_M on Nov 24^th, 2007, 9:51pm

Quote:

I also had to do the following to really wipe out the headache: Imitrex nasal spray, Maxalt dissovlable tablet and then 2 Vicodin.

There can be residual headaches for a period caused by stopping the vicodin, depending on the amount used over the 6 week period.

Quote:

This last phase has gone on for about 2 weeks, and it is just so unusual that I have the whole thing hanging on this long.

Maybe a possibility of migraines, but I'm not familiar with them.

Quote:

I get really bad headaches that are basically regular migraines and are only alleviated by taking an Imitrex 100 mg tablet, in which case they are completely eradicated.

I've never had several weeks of migraine-like headaches from stopping Imitrex, but also, depending on how much used, this could be due to the Imitrex:

Quote:

I just finished a VERY bad cycle--extreme pain for much longer than usual--more in the neighborhood of 5 or 6 weeks instead of the typical 3-4.

Actually, it might be unusual to go into cycle while expecting.

Quote:

When I was pregnant with my 3rd and 4th kids, I went into cycles about halfway through each pregnancy

All I can say. Glad the cycle's over.

Title: Re: Imitrex dependence? Need input!
Post by Annette on Nov 24^th, 2007, 10:12pm

Hi Heather

Its hard to tell whether its the imitrex causing these weird headaches that you described . However, I dont think you can become "dependent " on imitrex that way, its more like they are rebound headaches.

Any of the below is possible

1- They are migraines : do you get nausea and vision distortion such as flashes with them ? can you lie down with them? are they on 1 side or both? have you tried 50 mg trex instead of 100?

2- They are rebound headaches: too much imitrex or maxalt or vicodin can all cause rebound headaches. The only way to tell is to avoid them for 2 weeks and see if the headaches stop.

3- Withdrawal headaches: triptans and codeine change the level of serotonins and other chemicals in your brain, sudden stop after prolonged heavy use may cause a transient imbalance of the chemicals triggering some non specific headaches.

4- Heavy shadows: some people shadow heavily after a particularly long and hard cycle, especially if they had to use a lot of meds for it. These tend to ease off by themselves after a while.

5- Going chronic: I doubt this though, because you said these headaches are more like migraines. You need to have headaches every day for a year without 4 weeks break to be chronic so you shouldnt worry about that now anyway.

You didnt say you are on any preventive. Preventives such as verapamil and lithium or some other meds can help curb these milder headaches. Do you use oxygen?

Please go see your doctor and ask to check if you can try to stop using the triptan and just use oxygen/caffeine/water/ice and just tough them out for a couple of days to see? If they are rebound or withdrawal headaches that will help stop them more quickly.

I would also ask the doctor for preventives and oxygen for next time if you havent got them already. Oxygen works for migraines for many people too.

Painfree wishes to you.

Title: Re: Imitrex dependence? Need input!
Post by Bob_Johnson on Nov 25^th, 2007, 8:20am

To treat CH, Imitrex by pill and nasal spray are not the best forms to use. Consider trying the injection form before you make any final judgments.

And don't mix triptans!!

Title: Re: Imitrex dependence? Need input!
Post by lionsound on Nov 25^th, 2007, 8:56am

I got pummeled when i was pregnant with my third child. Migraines and CH.

the migraine type symptoms could be from the imitrex pills. When i as taking the pills they didn't help my CH and I felt that it perpetuated my migraine because I was taking the pills everyday. I'll probably never know officially if it was rebound or not, but i believe i got in a imitrex dependent rut because I was unsuccessfully treating my CH and migraines. At one point i was taking the trex pills like candy with very short relief periods. unfortunately the only way i broke these cycles was with a trip the the ER.

If you have never been diagnosed with migraine i suggest you get that looked at first because you want to treat it correctly. Also if you have 02 try it on the migraine..ya never know..sometimes it helps mine.

And support is the best med :)

ask more questions..we'll do our best to help you

-Rori

Title: Re: Imitrex dependence? Need input!
Post by heatherk on Nov 25^th, 2007, 9:28am

Thank you so much, everyone, for your thoughtful replies. Annette, your info in particular was helpful. I think I'm just shadowing heavily (a brilliant term--I had forgotten it!) since this cycle was so horrible.

In terms of mixing triptans, my neuro said it was okay to do the 20 mg Imitrex nasal spray and then a 10 mg Maxalt, but that it was NOT okay to do, for example, a 100 mg Imitrex tablet and then a Maxalt. I think if they are two lower-level triptans you are okay, but hey, I'm not an MD.

Anyhow, I have suffered regular migraines before, always during a cluster cycle, though--never on their own independently. Usually I'll cross over into regular migraine when I'm pregnant and in a CH cycle and that will last about a day or so. My regular migraines are pretty textbook--I vomit, can't lie down, have bilateral pain; but I've never had the visual disturbances that people report, or the classic "aura," (although, having been a CH sufferer for so many years, I think we all have our own version of experiencing an aura--we pretty much intuit when we are going into a cycle, don't we?).

I have 4 young kids and one is actually handicapped, so toughing out the last remnants of this most recent cycle is not possible for me unless I go away on my own for 4 or 5 days so that I can writhe around in bed and moan and groan without having any responsibilites. I may try to do that if this goes on much longer. I have a very supportive husband and my family can help out with the kids....I just want to stop feeling slave to these headaches. The holidays are coming and I can't even throw back a glass or two of wine!

Anyhow, thanks for the support!

Heather in NYC

Title: Re: Imitrex dependence? Need input!
Post by lionsound on Nov 25^th, 2007, 9:47am

Quote:

I just want to stop feeling slave to these headaches."

this i totally understand...

Heather,
Have you ever tried the imitrex injections?
For me the different mode of medication made a huge difference. The injections work far better than the pill. And I ended up using it less.

Also have you ever tried melatonin at night?

Title: Re: Imitrex dependence? Need input!
Post by heatherk on Nov 25^th, 2007, 9:50am

I haven't tried melatonin but am intrigued--what do I do? How much do I take? and what's the idea behind it as it relates to CH's? I know what melatonin is but don't see what it would do when it comes to CH relief.

Thanks in advance!

Heather

Title: Re: Imitrex dependence? Need input!
Post by George_J on Nov 25^th, 2007, 10:02am

Hello, Heather, and welcome.

Quite a few of us take melatonin while in cycle. Generally, we take somewhere between 6-12 mg., (beginning at the low end) about an hour before bedtime.

For many people (including me) it seems to reduce the number of nighttime hits that we get, and allows us to get an uninterrupted night's sleep. In my case, since 90 percent of my hits occur at night, it reduces the number of hits that I get during a cycle overall. It does not seem to increase the intensity of hits, nor does it seem to extend a cycle. Therefore, I consider it a valuable addition to my (admittedly conservative) CH arsenal.

It's not a magic bullet. It won't stop a cycle, nor will it reduce the number of hits to zero, but it helps to make the thing a bit more liveable.

I've not noticed any side effects from using it. Some folks report drowsiness the next day, but I can't say that I've had that happen.

YMMV. Check with your doctor before starting it, of course.

Best wishes,

George

Title: Re: Imitrex dependence? Need input!
Post by lionsound on Nov 25^th, 2007, 10:07am

(thanks george..you type faster than me ;;D)

Melatonin is an over the counter med, but check with you doc about taking it anyway. :)

Title: Re: Imitrex dependence? Need input!
Post by BarbaraD on Nov 26^th, 2007, 6:13am

You might also try Red Bull at the first sign of a HA (migraine or CH). Or the O2. It seems to abort for me if I get to it soon enough.

Melatonin at night (give it a week or two to get in your system - it's not instant). My neuro swears by it.

Wishing you PFDAN soon...

Hugs BD

Title: Re: Imitrex dependence? Need input!
Post by Bob_Johnson on Nov 26^th, 2007, 7:22am

Cephalalgia. 2005 Jun;25(6):403-11. Links

Melatonin, the pineal gland and their implications for headache disorders.

Peres M.

Brain Research Institute, Albert Einstein Hospital, Sao Paulo, Brazil.

Melatonin, the pineal gland and their implications for headache disorders. Cephalalgia 2005. London. ISSN 0333-1024There is now evidence that melatonin may have a role in the biological regulation of circadian rhythms, sleep, mood, and ageing. Altered melatonin levels in cluster headache and migraine have been documented. Melatonin mechanisms are related to headache pathophysiology in many ways, including its anti-inflammatory effect, toxic free radical scavenging, reduction of proinflammatory cytokine up-regulation, nitric oxide synthase activity and dopamine release inhibition, membrane stabilization, GABA and opioid analgesia potentiation, glutamate neurotoxicity protection, neurovascular regulation, serotonin modulation, and the similarity of chemical structure to that of indomethacin. Treatment of headache disorders with melatonin and other chronobiotic agents is promising. A double-blind, placebo-controlled trial shows melatonin is effective in cluster headache prevention, other studies also show benefit in other disorders. Melatonin plays an important role in headache disorders, offering new avenues for studying their pathophysiology and treatment.

PMID: 15910564
(Dosing commonly 9mg/day.-BJ)

Title: Re: Imitrex dependence? Need input!
Post by Kevin_M on Nov 26^th, 2007, 7:54am

on 11/25/07 at 09:28:08, heatherk wrote:

In terms of mixing triptans, my neuro said it was okay to do the 20 mg Imitrex nasal spray and then a 10 mg Maxalt, but that it was NOT okay to do, for example, a 100 mg Imitrex tablet and then a Maxalt. I think if they are two lower-level triptans you are okay, but hey, I'm not an MD.

This does not seem correct. An injection is something like 6mg because it goes direct, at once. The nasal is 20mg because of loss of absorption through the nose and slower rate of getting there. The 100mg loses much more through the stomach and much slower and gradual, but all may be relatively the same to be cautioned mixing into your system with another triptan.
Mixing a triptans, whether nasal, swallowed, or injectable would not seem to have a "lower level" if injectable or nasal is used.

That appears questionable.

Title: Re: Imitrex dependence? Need input!
Post by meb777 on Nov 27^th, 2007, 5:33pm

Hi Heather,
I'm experiencing the exact same thing. My cycle comes every 3-4 years and lasts about 4 weeks. This time around I used Imitrex nasal spray and oxygen to relieve the pain and it's worked great. I was using the imitrex at least 2 times a day. I'm now into my 6th week and am still getting headaches but they are different. Not as intense & feeling slightly different and come in the mornings and early evenings. I saw my neuro today and he believes it's because I've become dependant on imitrex and the headaches I'm having are rebound. I'm not to use the imitrex anymore and he's put me on a predisone taper.

I'm hoping that's the solution!

Best of luck!
Molly