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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Zomig as a Preventive Treatment?
        
(Message started by: DrBB on Nov 19^th, 2007, 2:06am)

Title: Zomig as a Preventive Treatment?
Post by DrBB on Nov 19^th, 2007, 2:06am

I typically use O2 as my primary abortive. However, I traveled internationally this past summer and was concerned that airlines/ships would not allow me to take my O2. My neurologist prescribed Zomig, but my insurance company wouldn't cover enough to get me through my trip. Anyway, the 30-45 minutes before it kicked in was making me nervous.

As a result, I wound up experimenting and found if I took 1.25 mg (.25 of a 5 mg tab) 3 times/day (about 4 hours after awakening, once more later in the day, and at bedtime), I could practically prevent onset of my CHs.

It's a lot more convenient than the O2 (though a whole lot more expensive if one is paying out of pocket), and because it worked as a preventive--for me in fairly small doses--I wonder if some others might find it to be a good alternative or supplemental treatment.

Question: I have seen/heard nothing about using triptans like Zomig as a preventive treatment for CH. Is there a medical reason for this? It seems to me that any abortive treatment that has a low risk of side effects could easily be used as a preventive treatment for those of us who get as many as four or five CHs per day when we are in a cycle. Anybody see a flaw in this reasoning? [smiley=huh.gif]

Clearly, I'm not suggesting this for everyone, but it did work for me this past summer. Has anyone else tried this type of treatment strategy before?

Title: Re: Zomig as a Preventive Treatment?
Post by LeLimey on Nov 19^th, 2007, 3:02am

You're a "doctor" and you are asking US about the effects of constricting your blood vessels that many more times a day?

Try frovatriptan. You can take two tablets a day as with all triptans but the half life is up to 26 hours.

That said, triptans are not meant to be used a s a preventative on a long term basis and I don't believe you would find any doctor who would consider that safe. Travelling is one thing, I use Frova as a prevent for plane journeys etc but at all other times I rely on O2.

Title: Re: Zomig as a Preventive Treatment?
Post by Bob_Johnson on Nov 19^th, 2007, 7:42am

Imitrex, the most effective, rapid acting triptans for CH, has been tried as a preventive--doesn't work. Better to stick with experience.
-----

HERE ARE TWO MAJOR DOCUMENTS WITH RECOMMENDED TREATMENTS FOR CLUSTER HEADACHE, ONE FROM A U.S. PHYSICIAN, THE SECOND FROM EUROPE.
_________________________________________
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. Rozen)
================
Treatment guidelines from Europe

------
A. May, M. Leone, J. Áfra, M. Linde, P. S. Sándor, S. Evers, P. J. Goadsby:
EFNS guidelines on the treatment of cluster headache and other
trigeminalautonomic cephalalgias.
European Journal of Neurology. 2006; 13: 1066–1077.

Download free full text:
http://www.efns.org/files/guideline_49.pdf
(Thanks to "cluster" for link.)

Title: Re: Zomig as a Preventive Treatment?
Post by DrBB on Nov 19^th, 2007, 9:33am

Thanks for the quick responses. BTW, LeLimey, the "dr" is for PhD, not MD. I hope that puts my question in a more reasonable perspective ;) .

LeLimey, I agree that triptans don't make sense as a primary preventive treatment, particularly if other remedies that are cheaper/safer work. From your response, it sounds like you do use the strategy at times, though (for air travel), and it sounds like it works for you [or am I reading too much into your using Frova for plane travel?].

Bob, thanks for the references. I'll check them out tonight. Bottom line on my post--I needed a reasonable option for travel--and the quarter-doses of Zomig worked! I neglected to add that when I returned home, I stopped the Zomig and--boom--headaches came back! I did return to using the O2 as an abortive until the cycle ended. As a result, I am convinced the Zomig worked--for me, this cycle at least--and I am still curious about whether others have had similar experiences. I did do this under my neurologist's care, so I wouldn't recommend--as LeLimey aptly points out--that anyone try this on their own without being monitored. My curiosity was based on not being able to find similar testimonials. This suggests to me that my experience was either incredibly unusual--or that there are good medical (or financial) reasons not to use Zomig or other triptans as preventives.

Thanks again for the quick responses!

Title: Re: Zomig as a Preventive Treatment?
Post by LeLimey on Nov 19^th, 2007, 10:05am

You're welcome - I know what it's like to be new, I try where possible to answer questions I can as quickly as I can - waiting is awful!

Right back to triptans as a preventative.
Yes I do use Frova as a preventative but only for very specific things. Air travel, a nights sleep when I can no longer function through lack of sleep or to get through an important day - meetings, social event's like weddings - that sort of thing.

If I try to use triptans as a preventative for more than 3-4 days in a row I get attacks breaking through which are a hell of a lot worse than my "usual" ones and almost impossible to abort. It's almost like "it" is kicking back at me - like it can think. (I have yet to be convinced CH can't think :-/ )

The other point is all triptans are vaso constrictors. Unlike O2 which only constricts blood vessels in your head, triptans constrict your entie vascular system which obviously must affect your heart in some way. That is why we are limited to two doses of triptans a day. Alot of people here who have multiple hits do use "The Imitrex tip" for splitting doses to abort more hits but they are still both using it only as an abortive and also - they are aware of the "risk".

The risk could be negligible for you or it could be huge. I don't know your medical history - I don't know if you are at any risk of heart disease but you might not be aware of that until you start pushing limits either!

This is a forum for people like us, who suffer from CH. We do what we do to get by but we do it knowing and making sure others know all potential side effects.

You asked about splitting doses or Zomig and taking it more often.

Personally I don't think that's a good idea as you are constricting your vascular system more than is necessary when you could achieve the same effect dosing with Frova at 12 hour intervals. I also think using vaso constrictors on a long term basis as a preventative is something you will never see any doctor or drug company making them "condoning" for lack of a better word.

To get bac to O2, alot of airlines now will arrange for you to have it inflight if you ask. Obviously they might not be so happy about your own supply in terms of safety from terrorists etc but they can arrange it. Ask whoever you usually deal with.

Do you ever use E tanks?

What countries have you been travelling to? Within the US you can get O2 delivered to wherever it will be needed and I can help with links for when you are travelling if its to Europe.

Hope that helps!!
Helen

Title: Re: Zomig as a Preventive Treatment?
Post by Bob_Johnson on Nov 19^th, 2007, 2:01pm

Knew I had this but could not find this morning!

Headache. 2004 Apr;44(4):361-4.

Eletriptan for the short-term prophylaxis of cluster headache.

Zebenholzer K, Wober C, Vigl M, Wessely P.

Department of Neurology, University of Vienna (Austria) Medical School.

BACKGROUND: A beneficial prophylactic effect from eletriptan 40 mg given to a single patient with cluster headache was observed. OBJECTIVE: To further evaluate the efficacy of eletriptan in the short-term prophylaxis of cluster headache. METHODS: We treated 18 patients; mean age, 40.5 years (standard deviation [SD], 9.9). The number of cluster headache attacks was recorded during a baseline period of 6 days, and during 6 days of treatment with eletriptan 40 mg twice daily. The primary outcome measure was the reduction in the number of attacks during the treatment period. RESULTS: In the 16 patients who completed the study (2 patients were lost to follow-up), the mean total number of attacks decreased from 10.9 (SD, 5.6) during baseline to 6.3 (SD, 3.7) during treatment with eletriptan (P=.01) The reduction in the number of attacks exceeded 50% in 6 patients. CONCLUSION: This small open-label study suggests that eletriptan 40 mg twice daily may be useful for the short-term prophylaxis of cluster headache.

PMID: 15109360 [PubMed - in process]
---------------
Issue is cost, of course. Less costly meds to prvent are on the table.

Title: Re: Zomig as a Preventive Treatment?(Been getting
Post by DrBB on Nov 19^th, 2007, 5:48pm

Helen/Bob,

You guys are special! In chronological order:

Helen, thanks for the offer. In fact, I don't travel much, but if I see it on the horizon around cluster time, I'll drop a line. Some background: When we had scheduled our 25th anniversary Mediterranean cruise for this past summer, I had no inkling I'd be in the midst of a cycle. (Been diagnosed since 1991, but have had them at least since 1989.) They had been slowly spreading out from 18 months between the start of consecutive cycles and had been up to 48 months until 2005, when my cycle came after about 20 months. Then last March, I got hit 18 months later. Even then, since my cycles typically lasted from 2-3 months, and the trip was almost 4 months down the road, I was confident the O2 would not be an issue. After month three passed and I was still suck O2 regularly, I consulted with my neurologist about bringing a triptan with me, and he recommended Zomig because my one experience with Imitrex was OK, but less than miraculous. The Zomig worked fine, if slowly, on those occasions I ran out of O2 but I was limited to 15 pills per month (insurance companies are wonderful... ;) ). The out-of-pocket was just a bit prohibitive, so I thought about options. Because my headaches tend to be fairly consistent each day, I discussed with my neurologist timing small doses of Zomig to slightly precede the likely onset time of the next headache. Since he knew what other meds I was taking and had my medical history, he OK'd the plan pending some shifting around of some of my other meds.

Then, about a week before we left for Europe, we implemented Operation Prevent (OK I just made that part up...). For the next three weeks, I had one headache--and a minor one at that, and for the two weeks we were away, I needed no O2 at all. Shadows I had, but only one incident I would describe as a low-level headache. When we arrived home, I canned the Zomig and went back to carrying--and refilling my 4 tanks. As far as I know, I had no bad effects of the three weeks on Zomig.

As I mentioned in my earlier posts, I certainly wouldn't recommend this treatment regimen as a primary preventive treatment. Reading about the possible adverse effects and interaction effects of the various triptans would be enough to keep me on the O2 road. And, of course, there is the relative out of pocket cost. But I was typically taking 7.5 mgs of Zomig per day--less than the 10 mg "max," and I was doing it for a limited time.

Given my apparently positive experience, I was just amazed that I couldn't find anything about the efficacy of triptans for prevention of CHs. I had anticipated something like, "The research shows triptans to be [effective/ineffective] for prevention of cluster headaches. Regardless, the [short/long] term effects of the medication are severe [e.g., permanent physical damage, death, who-knows-what], and so they should be used only to abort headaches."

Admittedly, I didn't do the most extensive search possible, but I thought I would have found something from an authoritative source in a half hour, something like--the reference that Bob found! Just something that suggested someone had thought, "Gee, if we could predict (reasonably) when a person with CH is likely to have the onset of individual headaches, could we time the administration of an abortive [triptan] to prevent--rather than abort--a CH? Or maybe even impact the duration of an entire cycle? Let's get a small grant, check it out, and publish the results in a medical journal!" But before Bob shared his 2004 Headache reference, I didn't find a one. [Thanks Bob!]

At the risk of beating a dead horse (something I have had fantasies of doing when in the midst of an uncontrolled CH [smiley=biggrin.gif] ), I agree for reasons of overall health and cost, triptans should not be routinely used as a preventive.

But I would say, too, under the right circumstances (and the abstract of the study that Bob provided supports this statement) it is not unreasonable to consider using a triptan (at least the ones that have been mentioned in this thread) as a preventive for a limited time, under the supervision of a knowledgeable physician, where the risks to the sufferer can be weighed against the benefits and any sign of detrimental effects of the treatment can be observed early.

With all of those caveats, I believe if even one CH sufferer can avoid "the devil" for even a few days--let's not throw out the baby with the bathwater.

In the meantime, wishing all a headache-free day! And a Thanksgiving to crow about! [smiley=laugh.gif]

Title: Re: Zomig as a Preventive Treatment?
Post by LeLimey on Nov 19^th, 2007, 5:55pm

I would suggest maybe considering stockpiling for next time - fill your prescription out of cycle so you have reserves when you are IN cycle - just a thought!

Here's wishing you loads of pain free time

Helen

Title: Re: Zomig as a Preventive Treatment?
Post by DrBB on Nov 19^th, 2007, 10:57pm

Hey Helen,

Quote:

I would suggest maybe considering stockpiling for next time

Started the day I got back to my O². ;)

I may never need to use the Zomig that way again. But why push my luck...?