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        Cluster Headache Help and Support >> Cluster Headache Specific >> Imitrex online
        
(Message started by: Stoic on Jan 31^st, 2008, 10:48am)

Title: Imitrex online
Post by Stoic on Jan 31^st, 2008, 10:48am

My insurance company will cover only nine 100 mg Imitrex tablets every 23 days. This might work for migraine sufferers, but it doesn't work well for cluster headache sufferers. In my current cycle, I seem to have at least one headache every day, and sometimes two. Even cutting the Imitrext tablets in half, I'm probably going to run short.

Without insurance, the local cost for nine Imitrext tablets is $440.00. I've seen much lower prices online, but I've never bought drugs online before, and even though these require a prescription, I'm a bit uncomfortable about purchasing Imitrex in this way.

Any advice?

Title: Re: Imitrex online
Post by RichardN on Jan 31^st, 2008, 11:08am

Do you have 02?

I can't use Imitrex, but from all the trex users here, it's my understanding that the tablets are considered all but useless for CH . . . as the attacks ramp up so fast . . . and many (attacks) would go on their own by the time the tablets take effect. That's a lot of $$ for a limited supply of meds that may/may not be effective.

I'm sure some informed trex users will be along to offer their advise.

Be Safe,

Richard

Title: Re: Imitrex online
Post by Ray on Jan 31^st, 2008, 11:20am

I firmly believe in the injectable formulation of Imitrex, the one that you draw up in a syringe yourself. I find that 1/2 dose or even 1/3 dose is effective. But to try to answer your question:

Step 1) Ask your physician to write a statement of medical necessity for your medication and submit it to your insurance company.

Step 2) Contact the insurance company and learn about the medical appeals process -- all insurance companies have one!

Step 3) If the other steps fail, contact the Glaxo Smith-Kline Patient Assistance programs, I believe I found the numbers, below:

GlaxoSmithKline Glaxo Wellcome Patient Assistance Program (800) 722-9294
(800) 546-0420 for SmithKlein Beecham Foundation Access to Care
(800) 699-3806 for Oncology products
(888) 825-5249 for Orange Card for seniors

Wish best wishes of success,

Ray

Title: Re: Imitrex online
Post by Stoic on Jan 31^st, 2008, 11:28am

Thanks to both of you for your replies. I should have added one additional piece of information — i.e., I'm not at all sure that the headaches I have are "cluster headaches" in the sense I've been reading about, here and elsewhere.

They came on a couple of months ago, with stuffiness and congestion (always on the left side), increased in frequency and severity, and now occur once or twice a day. Nothing wrong with my sinuses, and nothing shows up on a CT scan.

On the other hand, each headache comes on gradually, the pain is far less severe than what I've read about cluster headache, lying down is preferable to walking about, and the duration seems endless without medication. Even a half Imitrex works like a charm.

So these seem to be neither migraine nor cluster headache, but I do need a reliable supply of Imitrex for as long as this lasts.

Title: Re: Imitrex online
Post by vietvet2tours on Jan 31^st, 2008, 11:43am

Do you have o2?

Potter

Title: Re: Imitrex online
Post by hotprestwich on Jan 31^st, 2008, 11:50am

what potter said, 02 works wonders man,
sounds like you could have a mild cycle going on,
have you done the cluster quiz?
if it is mild thats great its different for everyone,
hope it ends soon for ya

Title: Re: Imitrex online
Post by Stoic on Jan 31^st, 2008, 12:04pm

Good questions.

No, I don't have O2 yet, although my neurologist has just told me that I should continue with Verapamil (240 mg) each day for another week or so, and if this doesn't work, we'll "shift gears." I think this means either a different drug or O2, which we've discussed before.

No, I haven't done the "cluster quiz," although I've seen references to it here. Where is it? Someone said it's "at the left," but there's nothing like that on the left of my web browser (Safari).

The more I read about cluster headache, the more I think these might be rebound headaches — in which case I'm doing the wrong thing by taking Imitrex again and again. I mentioned this to my neurologist, but he seemed to dismiss the possibility.

Title: Re: Imitrex online
Post by Ray on Jan 31^st, 2008, 12:10pm

http://www.clusterheadaches.com/quiz.html

Title: Re: Imitrex online
Post by DennisM1045 on Jan 31^st, 2008, 12:12pm

Hi ,

First off, using O2 and energy drinks I have reduced my triptan comsumption to an average of 1 dose a week when I'm in cycle. This combination is effective for many of us and it works without all the side effects of triptans. Namely rebound headaches.

Imitrex injections, Zomig nasal spray and Maxalt-MLT are far superior abortives for CH when compared to Imitrex pills.

If Ray's advice fails you, see if you can get your Dr to:

1. Perscribe you some Oxygen!

2. Perscribe Imitrex Injections - my insurance co limits me to 4, 4mg injections per month so getting it by the vial and using a syringe like Ray suggests stretches this out longer. I stockpile while out of cycle. Buy it every month and keep it in a cool dry place.

3. If you still feel like you are going to use up your supply, have him write a backup perscription for another triptan type.

Good luck. I hope you catch a break soon.

-Dennis-

Title: Re: Imitrex online
Post by DennisM1045 on Jan 31^st, 2008, 12:14pm

on 01/31/08 at 12:04:47, Stoic wrote:

The more I read about cluster headache, the more I think these might be rebound headaches — in which case I'm doing the wrong thing by taking Imitrex again and again. I mentioned this to my neurologist, but he seemed to dismiss the possibility.

I want to change option #1 on my list to:

1. Get a new Doctor

Clearly this guy doesn't know how to treat CH. Is he the same Dr who diagnosed you?

-Dennis-

Title: Re: Imitrex online
Post by Stoic on Jan 31^st, 2008, 12:24pm

I just did the cluster quiz and the results are unclear. As indicated in my earlier post, these are like CH in some ways, but clearly unlike CH in others.

To be fair to my neurologist, he hasn't given me a clear diagnosis of CH or of migraine. Whatever it is, he thinks it was caused by some disruption of my sleep cycles and REM sleep, perhaps caused by something I was taking (Vicodin, Melatonin, Lorazepam, etc.). But I haven't taken any of these things for weeks, and the headaches continue.

Again, I've been reading about rebound headache, and that seems to fit in several ways. But in that case, I shouldn't be taking Imitrex, but rather something like 5-HTP.

Or whatever.

Title: Re: Imitrex online
Post by Bob_Johnson on Jan 31^st, 2008, 12:39pm

If your doc suspects cluster, then the Verap. dose is much too small to test it. Two items to show him. In Dr. Rozen's article, point out his comments on dosing for Cluster.
-------
http://www.plainboard.com/ch/chtherapy.pdf

Here is a link to read and print and take to your doctor. It describes preventive, transitional, abortive and surgical treatments for CH. Written by one of the better headache docs in the U.S. (2002)
==================

Headache. 2004 Nov;44(10):1013-8.

Individualizing treatment with verapamil for cluster headache patients.

Blau JN, Engel HO.

Background.-Verapamil is currently the best available prophylactic drug for patients experiencing cluster headaches (CHs). Published papers usually state 240 to 480 mg taken in three divided doses give good results, ranging from 50% to 80%; others mention higher doses-720, even 1200 mg per day. In clinical practice we found we needed to adapt dosage to individual's time of attacks, in particular giving higher doses before going to bed to suppress severe nocturnal episodes. A few only required 120 mg daily. We therefore evolved a scheme for steady and progressive drug increase until satisfactory control had been achieved. Objective.-To find the minimum dose of verapamil required to prevent episodic and chronic cluster headaches by supervising each individual and adjusting the dosage accordingly. Methods.-Consecutive patients with episodic or chronic CH (satisfying International Headache Society (IHS) criteria) were started on verapamil 40 mg in the morning, 80 mg early afternoon, and 80 mg before going to bed. Patients kept a diary of all attacks, recording times of onset, duration, and severity. They were advised, verbally and in writing, to add 40 mg verapamil on alternate days, depending on their attack timing: with nocturnal episodes the first increase was the evening dose and next the afternoon one; when attacks occurred on or soon after waking, we advised setting an alarm clock 2 hours before the usual waking time and then taking the medication. Patients were followed-up at weekly intervals until attacks were controlled. They were also reviewed when a cluster period had ended, and advised to continue on the same dose for a further 2 weeks before starting systematic reduction. Chronic cluster patients were reviewed as often as necessary. Results.-Seventy consecutive patients, 52 with episodic CH during cluster periods and 18 with chronic CH, were all treated with verapamil as above. Complete relief from headaches was obtained in 49 (94%) of 52 with episodic, and 10 (55%) of 18 with chronic CH; the majority needed 200 to 480 mg, but 9 in the episodic, and 3 in the chronic group, needed 520 to 960 mg for control. Ten, 2 in the episodic and 8 in the chronic group, with incomplete relief, required additional therapy-lithium, sumatriptan, or sodium valproate. One patient withdrew because verapamil made her too tired, another developed Stevens-Johnson syndrome, and the drug was withdrawn. Conclusions.-Providing the dosage for each individual is adequate, preventing CH with verapamil is highly effective, taken three (occasionally with higher doses, four) times a day. In the majority (94%) with episodic CH steady dose increase under supervision, totally suppressed attacks. However in the chronic variety only 55% were completely relieved, 69% men, but only 20% women. In both groups, for those with partial attack suppression, additional prophylactic drugs or acute treatment was necessary. (Headache 2004;44:1013-1018).

Title: Re: Imitrex online
Post by Gena on Jan 31^st, 2008, 5:48pm

on 01/31/08 at 11:20:45, Ray wrote:

Step 1) Ask your physician to write a statement of medical necessity for your medication and submit it to your insurance company.

Step 2) Contact the insurance company and learn about the medical appeals process -- all insurance companies have one!

Ray

Just a FYI, I read this and set an appointment with my insurance rep. I found out that all I have to do to get rid of the limit on my imitrex and Thomas' zomig was to have the Dr's fill out a form stating that our Diagnosis is not the M word but Clusterheadaches and the restriction will be lifted.

I have made several calls and this is the first time I have heard this.

Thanks for the info.

I guess you do learn something new every day! 8)

Title: Re: Imitrex online
Post by Karla on Jan 31^st, 2008, 7:25pm

I would try the oxygen first because that should not have any rebound effect to it and may help you stop your pain and no need to try to up your imitrix limit.

I would also say that many of us here have tried up to 960mg of verapamil. So dont be afraid to go higher if needed. I would hate to rule out a medicine as not working if it isn't fully tried to its potential.

IF all else fails. Get a script for imitrix pills, imitrix shots and imitrix nasal sprays. Zomig also works in pill and nasal spray form much like imitrix does. Ask to try it but not within 24 hours of trying imitrix. They cant be taken together or you may have a serious side effect. There is also axert, amerge, frova, maxalt, etc. You can try these also and see how they help you. Amerge and Frova are supose to keep you ha free for around 12 hours. Thus there is no need to take alot of it. For me it only kept the ch away for 2 hours then they came back full force. Maxalt made my ch more worse and intense. Axert works just as good as zomig and imitrix for me. The important thing to remember is we are all diferent and what does or doesn't work for me may be different for you. That is why I would encourage you to experiment with your drs help and see what works for you and what doesn't and see how you can get around your insurance problem limiting you. good luck!

Title: Re: Imitrex online
Post by MJ on Jan 31^st, 2008, 8:51pm

on 01/31/08 at 12:24:18, Stoic wrote:

Stoic

You may be right and do not have cluster headaches.
I may be wrong.

They as you describe sound more like drug induced headaches.
Vicodin has that ability.
Perhaps by treating you are lengthening the process.

I am not trying to be flippant but try strong coffee instead of Immitrex and see if that helps.

Do you have a previous history of CH?

At any rate your doc is shooting in the dark and I would go for a definitive diagnosis.

Title: Re: Imitrex online
Post by Stoic on Jan 31^st, 2008, 9:50pm

No previous history of CH, MJ. I'd not thought of coffee, but I'll give it a try next time I feel one coming on. I've had some success lying down with an ice pack, alternately at the back of my neck and the left side of my face, where the headaches always come.

If the Verapamil works, I should begin to have fewer headaches, and thus need the Imitrex less and less often. Because of the shortage, I never take more than 50 mg for any given headache, so gradually it should be getting out of my system.

These could indeed be rebound, drug induced, etc.

Title: Re: Imitrex online
Post by Rosebuddy on Apr 2^nd, 2008, 11:53am

I am using Imitrex tablets for the first time, and am having good success. However, I thought I was about through with this cycle. When it started, I tried a few other drugs which weren't particularly effective - Fiorinol (a true disaster), Cafergot (used my weekly maximum in 2 days), Nortriptiline (not good for me!). My doctor wouldn't prescribe Imitrex b/c she said it needed to be monitored the first time and I never had a headache during the day! Finally, I "lucked out" and had one during Urgent Care hours, so got an injection which could be monitored. I then got a prescription for 9 pills, which I cut in thirds. They are a hard shape to divide.

Since my cycle is sort of ending, I have only been getting shadows to Kip 4s, and if I take one-third of a tablet when it starts to ramp up I can abort within 30 minutes. My usuals are 3 hours, and since these aren't real headbangers 30 minutes is acceptable. The problem - I was down to every day, and now am getting these mild ones at least twice a day. Am I blowing it by taking the Imitrex? I guess I better work harder on finding a Neuro! You guys are good, though.

Title: Re: Imitrex online
Post by Stoic on Apr 2^nd, 2008, 12:17pm

Sorry to be away for so long. As indicated in a previous post, I've become convinced that my problem isn't CH, but rather chronic migraine. Taking Verapamil and Imitrex, I've reduced the number of my headaches from 20 in January, to 14 in February, to 10 in March (so far none in April). :-)

The anxiety over my Imitrex supply -- which led me to start this thread -- has abated proportionately.

But now I have a related question. While I've built up a stash of Imitrex, it's by no means inexhaustible if I start having daily headaches again. My wife and I are taking a 17-day vacation in England and Scotland next month, and I'm worried about falling short. How easy is it to get Imitrex in Great Britain? I've heard it's not difficult, but I'm hoping there are some Brits on this board who might be able to confirm this.

Thanks.

Title: Re: Imitrex online
Post by thebbz on Apr 2^nd, 2008, 1:37pm

There are brits here............HELEN! Whats the poop with the imigran over there.
thebb

Title: Re: Imitrex online
Post by CostaRicaKris on Apr 2^nd, 2008, 8:15pm

on 04/02/08 at 11:53:46, Rosebuddy wrote:

if I take one-third of a tablet when it starts to ramp up I can abort within 30 minutes.

I can go from 0-10 in 30 minutes. The pills would take too long for me.

Title: Re: Imitrex online
Post by thebbz on Apr 4^th, 2008, 2:40pm

Good info...bump
thebb :)