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        Cluster Headache Help and Support >> Cluster Headache Specific >> Visine shortens length of CH for me
        
(Message started by: LetItSnow on Jan 15th, 2008, 5:53pm)
Title: Visine shortens length of CH for me
Post by LetItSnow on Jan 15th, 2008, 5:53pm
Has anyone else gotten relief from using visine? For me, it will shorten the intense pain within 5-20 min of an attack that occurs while I am awake- it has little effect if I am awakened in the middle of the night.

Also, I have been CH free for 2 1/2 years on 180mg of verapamil, then without any warning, they are back. Doc has increased me to 360mg over the last 2 weeks, and no relief in site. Imitrex works wonders, but Doc says I can't use it 1-2x a day for weeks... I start Oxygen tomorrow.

Do CH get worse as you age ?  
Title: Re: Visine shortens length of CH for me
Post by monty on Jan 15th, 2008, 6:10pm
Most of those type of products are vasoconstrictors - is that brand tetrahydrozoline, oxymetazoline or a related compound?

Not sure if it works directly or indirectly on the trigeminal when added to the eye ... that's possible.  

Great if it works for you.  

Long term use of any of the 'get-the-red-out' drops is bad for the eyes; it reduces blood flow and oxygen to the eye.  As with nasal decongestants, there is probably a risk of rebound if you use it for more than a few days and then stop.  
Title: Re: Visine shortens length of CH for me
Post by LeLimey on Jan 15th, 2008, 6:13pm
Hello letitsnow! You'll forgive me if I say I hope it bloody well doesn't I hope!  ;)

Is your doctor planning on increasing your verap further? That's still a relatively low dose for a ch'er.

visine are eye drops right? I just googled it and found this

The active ingredients in the original Visine formulation are potassium chloride and tetrahydrozoline hydrochloride which is a vasoconstrictor, and therefore constricts the eye's superficial blood vessels to "get the red out",

vaso constrictors are what O2 and imitrex are so potentially it could be helping. Coffee and high energy drinks such as red bull are also full of caffeine which is a vaso constrictor too and alot of us have found them very helpful. "Red Bull" or cheaper equivalents also contains taurine which acts as a turbo boost for the caffeine, intensifying it's effect and it can really knock an attack on it's head if you catch it early enough.

Have you ever tried melatonin for night time hits?

I have only ever heard CH improves with age - allegedly but I suppose that depends on how old you are now for that to be any potential comfort!!

Hang in there, we'll help all we cna
Helen
Title: Re: Visine shortens length of CH for me
Post by monty on Jan 15th, 2008, 6:34pm
I was emailing someone a few years ago that accidentally touched his eye with a finger that had capsaicin cream on it - not only was it very painful to have hot pepper stuff in the eye, it also aborted immediately. Not something that is advisable, but it does demonstrate a link between the eye and the trigeminal.  

Might be nice someday if a 50 microgram dose of imitrex in an eye drop could abort without the risk of heart issues. I am not advising that anyone try this on their own - no idea what else is in a vial along with the trex, or what effect it might have on the eye. There might be some other chemical that works even better - food for thought.

Title: Re: Visine shortens length of CH for me
Post by Annette on Jan 15th, 2008, 7:46pm

on 01/15/08 at 17:53:55, LetItSnow wrote:
Has anyone else gotten relief from using visine? For me, it will shorten the intense pain within 5-20 min of an attack that occurs while I am awake- it has little effect if I am awakened in the middle of the night.

 



This is an interesting finding. I am not so sure if the relief you find is actually from the visine or is it just the attack fading on its own. Visine is a vasoconstrictor but a very weak one. Its designed to vasoconstrict capillaries on the surface of the eye only, not the deeper larger blood vessels.

Furthermore most of the drops will be diluted by natural tear and drained out through the tear duct. The drops will only stay in contact with the eye for about 2 minutes, not long enough to be absorbed deep into the eye. The bioavailablity of most eye drops is only 10%. As soon as its absorbed into the capillaries on the surface of the eye, it will constrict those resulting in even less blood flow preventing further deep absorption.

In a CH attack, the carotid artery and its branches are the ones being dilated and they are fairly large blood vessels. If visine can constrict those then it would cause severe damage to the eyes as all the blood vessels supplying the eyes would shut down. This will kill the very fragile and sensitive optic nerve and the retina. Being a OCT med, it can not legally have therapeutic effects strong enough to cause such damage.

In the same token, I dont believe administering strong vasoconstrictors via the eye is a plausible route.

You may need to time and compare the level of pain and the length of the hits when not using visine with the ones using visine. Relief felt 20 mins into a hit can just be the hit itself dissipating.
Title: Re: Visine shortens length of CH for me
Post by monty on Jan 15th, 2008, 8:33pm
OK, it can't be a direct vasoconstrictor. But what about indirect effects?  When a nerve-block is given, I don't think any of the active ingredient makes it to the trigeminal nerve or the carotid artery. And all of the stuff injected in a nerve block is metabolized within hours or a few days tops ... yet a nerve block can sometimes last weeks or even break a cycle.
Title: Re: Visine shortens length of CH for me
Post by Jonny on Jan 15th, 2008, 9:36pm
Not taking any sides here, but I can get rid of 75% of shadows with Visine. I have been doing it for years.

As for long term use, I use it when I get up and when I leave work. In the morning I have the typical bloodshot, as a metal polisher I use it to clear my eyes for the ride home.......Ive been doing this for 15 years.

Not sure if this helps anyone, but thats what I do. ;;D
Title: Re: Visine shortens length of CH for me
Post by LetItSnow on Jan 19th, 2008, 1:17pm
My typical CH lasts about 45 min when I am awakened from sleep. Maybe 25% of the time visine will shorten this to 15 minutes.

When I get a CH in the middle of the day, visine has shortened it to 15 min. about 95% of the time.

It has been this way for since I have been using visine during CH. I told my doctor about this and he shrugged his shoulders and said if it works, keep doing it.  So I do.
Title: Re: Visine shortens length of CH for me
Post by BarbaraD on Jan 19th, 2008, 2:34pm
My opthomologist told me not to use anything with presertatives in it (Visine has presertatives in it), so I've never tried it, BUT now I will..... (when did I ever listen to a damn eye doc? [smiley=huh.gif] ;;D ).

Hey, if it works -- next time I get to a store I'm definitely gonna try some.... has to beat the banana peels around the head (ok it was worth a try - the witch doctor said it would work!)

I'm not trying to be cute - I am gonna try it. If Jonny says it works for him - that's good enough for me. My question is WHY the hell (this is for Jonny) haven't you said something BEFORE NOW?

Hugs BD
Title: Re: Visine shortens length of CH for me
Post by Jonny on Jan 20th, 2008, 1:22am

on 01/19/08 at 14:34:02, BarbaraD wrote:
If Jonny says it works for him - that's good enough for me. My question is WHY the hell (this is for Jonny) haven't you said something BEFORE NOW?


Sorry baby, I just never thought about it as an abortive.....Letitsnows post reminded me that I have had some luck with it for shadows.

Im sorry, Mom......no supper for me tonight.  :'(

;;D
Title: Re: Visine shortens length of CH for me
Post by George_J on Jan 20th, 2008, 2:14am

on 01/15/08 at 17:53:55, LetItSnow wrote:
Do CH get worse as you age ?  


On the contrary....for what it's worth, I'm an episodic who used to get hit twice a year.  My last three cycles have been three years apart.  So in some sense, I suppose they're getting better.  At least, they seem to be getting less frequent.

Best,

George
Title: Re: Visine shortens length of CH for me
Post by Annette on Jan 20th, 2008, 3:46am

on 01/15/08 at 20:33:36, monty wrote:
OK, it can't be a direct vasoconstrictor. But what about indirect effects?  When a nerve-block is given, I don't think any of the active ingredient makes it to the trigeminal nerve or the carotid artery. And all of the stuff injected in a nerve block is metabolized within hours or a few days tops ... yet a nerve block can sometimes last weeks or even break a cycle.



Sorry havent been back to this thread for a while.

I cant comment on indirect effect of visine as a vasocontrictor but I dont think it can be compared to a nerve block. A nerve block often contain more than 1 quite powerful chemicals ranging from anaesthetic to neuroleptic and they are injected directly into nerve ganglion(s), which is where many nerve branches converge. How well does a nerve block last often depends on how skillful the person administering the block is and how accurate was the position of the block in regards to the affected nerves. It has nothing to do with indirect effect of the chemicals.

BTW, I have never heard of a nerve block breaking a cycle. Where did you get that information from Monty?

However, its interesting that people have found some relief of CH pain with visine drops. It makes me wonder if and how much of the eye pain is actually surface pain ie pain felt on the surface of the eye. We all know that eyes are very sensitive and even a speck of dust can cause a great deal of discomfort.

Its worth a try I guess. Has anyone else tried this and found good results?
Title: Re: Visine shortens length of CH for me
Post by monty on Jan 20th, 2008, 3:04pm

on 01/20/08 at 03:46:27, Annette wrote:
BTW, I have never heard of a nerve block breaking a cycle. Where did you get that information from Monty?


I don't remember the exact source - it may have been someone who got a week or two of relief from a block, and happened to go out of cycle while pain free. Not sure that would really count as breaking a cycle.  

My main point was that the nerves in the neck can influence the trigeminal and cluster pain, so why not the optical nerve? That nerve is even closer anatomically, and there is bound to be cross-talk between them.
Title: Re: Visine shortens length of CH for me
Post by Annette on Jan 20th, 2008, 3:32pm
Monty, it seems you are not talking from a point of actual knowledge but from speculation.

How nerve block works is anatomically proven. The chemicals are injected into the nerve ganglions at the base of the skull, this is the roots of the trigeminal nerves. Do you actually have an understanding of the anatomy and the distribution of the trigeminal nerves?

If you think that during a nerve block, injections are just given nilly willy somewhere in the neck/head hoping that it will somehow absorbed into the vicinity of the trigeminal nerves to numb it then you are wrong.

It just cant be compared to how visine may work in reducing the eye pain, the 2 are very different.

Edited to add: The optic nerve is not a pain sensory nerve, it doesnt cause pain. There are different types of nerves, only the sensory ones can feel ie cause pain.
Title: Re: Visine shortens length of CH for me
Post by LeLimey on Jan 20th, 2008, 6:09pm
Did you mean a GONB? A Greater Occipital Nerve Block? If so I know many people here in th eUK and also  in the US who have had them. Some with great success and others sadly not but I think personally it depends on the skill and experience of the person administering it.
Title: Re: Visine shortens length of CH for me
Post by LeLimey on Jan 20th, 2008, 6:10pm

on 01/20/08 at 15:32:25, Annette wrote:
Monty, it seems you are not talking from a point of actual knowledge but from speculation.

How nerve block works is anatomically proven. The chemicals are injected into the nerve ganglions at the base of the skull, this is the roots of the trigeminal nerves. Do you actually have an understanding of the anatomy and the distribution of the trigeminal nerves?

If you think that during a nerve block, injections are just given nilly willy somewhere in the neck/head hoping that it will somehow absorbed into the vicinity of the trigeminal nerves to numb it then you are wrong.

It just cant be compared to how visine may work in reducing the eye pain, the 2 are very different.

Edited to add: The optic nerve is not a pain sensory nerve, it doesnt cause pain. There are different types of nerves, only the sensory ones can feel ie cause pain.


Annette the only one (nerve block) I know of is directly into the occipital nerve at the back of the neck - it's only done at the Institute of Neurology here to myknowledge (based on last year so I'm quite possibly wrong on that point)

Hope that helps
Helen
Title: Re: Visine shortens length of CH for me
Post by monty on Jan 21st, 2008, 1:29pm

on 01/20/08 at 15:32:25, Annette wrote:
Monty, it seems you are not talking from a point of actual knowledge but from speculation.

How nerve block works is anatomically proven. The chemicals are injected into the nerve ganglions at the base of the skull, this is the roots of the trigeminal nerves. Do you actually have an understanding of the anatomy and the distribution of the trigeminal nerves?

If you think that during a nerve block, injections are just given nilly willy somewhere in the neck/head hoping that it will somehow absorbed into the vicinity of the trigeminal nerves to numb it then you are wrong.

It just cant be compared to how visine may work in reducing the eye pain, the 2 are very different.

Edited to add: The optic nerve is not a pain sensory nerve, it doesnt cause pain. There are different types of nerves, only the sensory ones can feel ie cause pain.


1) Visine is not as weak as you describe it. It's action is not limited to the surface capillaries of the eye. It is strong enough to temporarily alleviate the symptoms of horner's droop:  "Patient use of Visine (tetrahydrozoline) masks Horner syndrome."  Br J Ophthalmol. 2008 Jan;92(1):149-50.
   
2) Optic nerve?  I should have said ophthlamic nerve. My bad. The ophthalmic nerve is a sensory nerve, and it is involved in clusters and horner's syndrome.  

3) The anatomic/theoretical basis of an occipital nerve block is not proven - there is a theoretical rationale, but little proof of the how and why. This nerve block is of the occipital nerve (not the trigeminal), which appears to reduce inputs to the trigeminal (indirectly, as I alluded to in a previous post). This is rather different from a classic nerve block, which is placed in between the pain and the brain to directly disrupt the transmission of pain signals.

In the case of ONSI (occipital nerve stimulator implants), the direct target is clearly not the trigeminal nerve. And yet that can be an effective treatment - there is something else going on - an indirect change in activation, neural gating, peripheral processing, spread of allied reflex, or something similar. Yes, I am only speculating about what that might be, but it is not 'willy-nilly' as you suggest.






Title: Re: Visine shortens length of CH for me
Post by Annette on Jan 21st, 2008, 2:57pm

on 01/21/08 at 13:29:49, monty wrote:
there is something else going on - an indirect change in activation, neural gating, peripheral processing, spread of allied reflex, or something similar. Yes, I am only speculating about what that might be, but it is not 'willy-nilly' as you suggest.



I would love to hear the basis of your speculation. Lets all learn something here but I hope you have a good scientific base for the speculation.

Please elaborate on activation, neural gating, peripheral processing, allied reflexes ....

Thank you and I appreciate a good debate.
Title: Re: Visine shortens length of CH for me
Post by Annette on Jan 21st, 2008, 3:03pm

on 01/21/08 at 13:29:49, monty wrote:
1) Visine is not as weak as you describe it. It's action is not limited to the surface capillaries of the eye. It is strong enough to temporarily alleviate the symptoms of horner's droop:  "Patient use of Visine (tetrahydrozoline) masks Horner syndrome."  Br J Ophthalmol. 2008 Jan;92(1):149-50.
 




The article you quoted is not a free one, have you got a subscription to the Journal or have you bought the article to read it in its entirely? Or did you just quote it from its title?

From the abstract it said the finding was on ONE patient. I wonder if the rest of the article cite how common is this effect ?
Title: Re: Visine shortens length of CH for me
Post by midwestbeth on Jan 22nd, 2008, 2:02pm
I use Visine everyday.  I have blue eyes and they are sensitive to smoke, sun, or just plain exhaustion. I use it in the morning and at the end of the day.  I also use it after a ch, due to the bloodshot left eye.  

I have never tried using Visine at the start of a ch.  I  carry some in my purse, so next time I'll give it a try and see what happens.  Hmmmmm

Beth
Title: Re: Visine shortens length of CH for me
Post by Travis1980 on Jan 22nd, 2008, 2:08pm
I tried to use Visine yesterday morning when I woke up with that awful feeling of dread. That turned into a Kip 8 and  I don't know if this had anything to do with it, but my headache lasted for six hours and only gave in when I used the imitrex injection. Who knows. I am atypical in that I my CHs last for 1-6 hours in cycle if I don't use an abortive. But the Visine certainly did not help me.


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