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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Warfarin and refractory chronic CH - 1 case report
        
(Message started by: Annette on Feb 20^th, 2008, 4:16pm)

Title: Warfarin and refractory chronic CH - 1 case report
Post by Annette on Feb 20^th, 2008, 4:16pm

REMISSION OF REFRACTORY CHRONIC CLUSTER
HEADACHE AFTER WARFARIN ADMINISTRATION

Case report

Below is an excertp from the article and the link to the article

DISCUSSION
In the present case, it is necessary to consider the
possibility of coincidence, but the patient had presented
cluster headache crises for more than six
years, with no effective control, spite of being in use
of suitable medications. With the use of warfarin and
achievement of INR 2.5, there was the remission of
crises. When it was necessary to replace warfarin with
heparin, the crises returned and, once more, they
have ceased with the return to oral anticoagulant.
An important datum is that the patient was a
smoker, and consumed about 20 cigarettes a day,
and the relief during the first hospital admission
could be attributed to the smoking habit interruption.
However, during the second hospital admission,
when the warfarin suspension produced the
return of crises, the patient had not smoked for
months and the crises remitted only when the use
of warfarin was returned.
Our evaluation is that, as it occurs for some patients
with migraine, warfarin may have a preventive
effect on the cluster headache.
This is the first case in the literature, as far as
we know, of a patient with chronic cluster headache
refractory to treatment presentig complete remission
of the crises following administration of warfarin
for another purpose.

http://www.scielo.br/pdf/anp/v62n4/a29v62n4.pdf

There had been mentions in the past that the coagulation factors in some CHers have been found to be higher than the normal population. However, this is the first case report of warfarin working to reduce hits in a refractory chronic CH.

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Ray on Feb 20^th, 2008, 6:26pm

Well, I'll be dog gone!

Thanks Annette, I would have never guessed that a "blood thinner" would/could be effective for anyone's CH.

Wishing you well,

Ray

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Guiseppi on Feb 20^th, 2008, 6:37pm

You research types, could that be why the water water water treatment helps? Does hydration cause a thinnng of the blood?

Guiseppi

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by nani on Feb 20^th, 2008, 6:44pm

http://www.med-owl.com/clusterheadaches/tiki-index.php?page=Anticoagulants

Title: Re: Warfarin
Post by vietvet2tours on Feb 20^th, 2008, 6:53pm

http://broadwayhockey.com/wp-content/uploads/2007/07/hockeyrodentjpg-1.jpg

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Guiseppi on Feb 20^th, 2008, 7:03pm

Interesting link Nani....Taurine really jumped off that list!!!! As did the reference to moyamoya....

Guiseppi

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Annette on Feb 20^th, 2008, 7:08pm

on 02/20/08 at 18:37:25, Guiseppi wrote:

You research types, could that be why the water water water treatment helps? Does hydration cause a thinnng of the blood?

Guiseppi

Its possible Joe, I am not sure. Excess hydration does cause thinning of the blood but I dont know if its how it works.

Here though, its interesting that Heparin didnt help the CH but Warfarin did, but it had to be at a level high enough of INR 2.5 to work.

So it appears not all anticoagulant would work. Therefore the mechanism would be more complex than just simple thinning of the blood.

Wonder of anyone here is on warfarin and whether it has made any difference?

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Annette on Feb 20^th, 2008, 7:18pm

Found this :

" Vitamin K is known to have a role in the central nervous system (CNS), inducing nitric oxide (NO), another chemical compound which can cause blood vessels to dilate. These compounds, as previously stated, may play a role in triggering the onset of a headache attack. The link between warfarin and its utility in cluster headaches may be through this mechanism. Kowacs et al. suggested that if warfarin can decrease vitamin K in the CNS, it may also decrease NO, leading to less vasodilation, and raising the threshold needed to trigger a headache attack. 1, 3 Warfarin has also been suggested to trigger or potentiate cluster headache attacks. 2 This article of case reports, however failed to propose a mechanism by which warfarin may have caused these attacks. Nevertheless, warfarin utility in this disease remains to be fully seen. "

This is from

http://www.warfarinfo.com/headaches.htm

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Annette on Feb 20^th, 2008, 7:24pm

Found further cases

Warfarin as a therapeutic option in the control of chronic cluster headache: a report of three cases

Journal The Journal of Headache and Pain

Abstract
Chronic cluster headache remains refractory to medical therapy in at least 30% of those who suffer from this condition. The lack of alternative medical therapies that are as effective as, or more effective than, lithium carbonate makes new therapies necessary for this highly disabling condition. Based on a previous report, we gave oral anticoagulants to three patients with chronic cluster headache. Two of them remained cluster headachefree while taking warfarin. In the third patient, the use of warfarin for three weeks initially increased the frequency and intensity of cluster headache attacks but subsequently induced a prolonged remission. In spite of the paucity of data available, oral anticoagulation appears to be a promising therapy for chronic cluster headache.

http://www.springerlink.com/content/hut2r8w77686527u/

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by E-Double on Feb 20^th, 2008, 7:52pm

BobJ posted abstracts about similar studies regarding warfarin use.

Interesting

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by nani on Feb 20^th, 2008, 8:11pm

I know Bob has also, Eric. :) I was too lazy to find and link those threads.

Guiseppi, that site is an excellent resource. It was written by one of our own, the man who brought us kudzu.
*sniff*

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by E-Double on Feb 20^th, 2008, 8:12pm

http://www.ouch-us.org/medications/warfarin.htm

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Annette on Feb 20^th, 2008, 10:58pm

Great ! It looks like there have been mention of this before and it got even Eric interested enough to read and to search. :)

I havent seen it discussed here before though, at least for the last 2 years or so.

Wonder if there are other articles out there on warfarin and chronic CH. If anyone find any thing else related please post.

Is there anyone here on warfarin who can share the experience?

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Ace_Sterling on Feb 21^st, 2008, 12:19am

I have never used Warfarin but I have myself on a blood-thinning regiment. I have know that dehydration (which creates thicker blood) can trigger mu CH. I used to hydrate trying to abort and found that I was over hydrating.

If you are going to hydrate, make sure to add Gatorade so you electrolytes stay solid.

My blood thinning regimen is 2 Excedrin Migraine 2 tabs, 2 times a day. 8 glasses of water, gatorade, etc. Omega-3 supplement, AND Plavix.

The plavix made a huge difference for me and it is safer than taking warfarin in my opinion.

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Bob_Johnson on Feb 21^st, 2008, 9:03am

This is the abstract I posted in 2005 but this approach is clearly not getting much attention: only two abstracts like this one, the other being from 2004.
=======

J Headache Pain. 2005 Oct;6(5):417-9. Epub 2005 Aug 1.

Warfarin as a therapeutic option in the control of chronic cluster headache: a report of three cases.

Kowacs PA, Piovesan EJ, de Campos RW, Lange MC, Zetola VF, Werneck LC.

Headache Section, Neurology Division, Internal Medicine Department, Hospital de Clinicas, Universidade Federal do Parana, Rua General Carneiro 181/1236, 80060-900 Curitiba, Brazil. cefaleia@hc.ufpr.br

Chronic cluster headache remains refractory to medical therapy in at least 30% of those who suffer from this condition. The lack of alternative medical therapies that are as effective as, or more effective than, lithium carbonate makes new therapies necessary for this highly disabling condition. Based on a previous report, we gave oral anticoagulants to three patients with chronic cluster headache. Two of them remained cluster headache-free while taking warfarin. In the third patient, the use of warfarin for three weeks initially increased the frequency and intensity of cluster headache attacks but subsequently induced a prolonged remission. In spite of the paucity of data available, oral anticoagulation appears to be a promising therapy for chronic cluster headache.

Publication Types:
Case Reports

PMID: 16362716

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by E-Double on Feb 21^st, 2008, 10:53am

on 02/20/08 at 22:58:54, Annette wrote:

Great ! It looks like there have been mention of this before and it got even Eric interested enough to read and to search. :)

I'm under the weather and a bit testy so I am hoping that I read the tone incorrectly.

This to me comes across as condescending and makes me appear to benot only uneducated but a casual bystander in our community. I have presented numerous research as well, in addition to emassing a nice little library of information that is typically provided to newbies.

We have people here who continuously share current and pertinant research in hopes of expanding the knowledge base of other "sufferers" or at least increasing the amount of information that can be provided to doctors.

I thank you posting information and for making me feel like $hit.

Sorry for the hijack and back to the literature

Eric

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by nani on Feb 21^st, 2008, 12:14pm

on 02/21/08 at 10:53:17, E-Double wrote:

I'm under the weather and a bit testy so I am hoping that I read the tone incorrectly.

If you read it incorrectly, sweetie, so did I.

Annette, why choose to use your sarcasm on Eric? One of the most helpful, informative and kind members here?

I'm the one you're pissed at. 8)

I'm not really concerned about a hijack... the above links are all there is on it.

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by pattik on Feb 21^st, 2008, 1:50pm

on 02/21/08 at 12:14:35, nani wrote:

I'm the one you're pissed at. 8)

I'm not really concerned about a hijack... the above links are all there is on it.

Well...maybe me too, a little. ;)
I think you're right about there being little else to find on the subject (for CH anyway).

Here's an interesting coincidence...today happens to be the anniversary of Carl Henrik Dam's discovery of vitamin K as a dietary factor in blood clotting. He subsequently won a Nobel Prize for his work.
http://web.lemoyne.edu/~GIUNTA/week.html

Also, Warfarin happens to be an acronym for the place that developed it--from Wikipedia--

Quote:

(The name warfarin stems from the acronym WARF, for Wisconsin Alumni Research Foundation + the ending -arin indicating its link with coumarin.) Warfarin was first registered for use as a rodenticide in the US in 1948, and was immediately popular; although it was developed by Link, the WARF financially supported the research and was granted the patent.

Personally, I think there are plenty of ways, including prescription, nonprescription, and even diet to thin one's blood if that's your goal. I also don't give much credence to a single patient case which by itself may very well be an aberration.

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by aubmari on Feb 21^st, 2008, 3:30pm

on 02/20/08 at 18:37:25, Guiseppi wrote:

You research types, could that be why the water water water treatment helps? Does hydration cause a thinnng of the blood?

Guiseppi

I have a very recent history of anemia and went to the ER two days after starting Iron Supplements (supposed to bring numbers up) and had lower numbers than before I started Iron.

I asked how that could be and was told that I was probably more hydrated that day and that accounted for me being lower.

Sounds similar to what you were asking. And truth be told I haven't had a cycle the entire time I have been anemic. Could be completely off base, but ya never know.

Aubmari

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by LeLimey on Feb 21^st, 2008, 3:39pm

Aubmari I'm severely anaemic too. In fact I have pernicious anaemia and my folic acid is shot to bits too. I'm having B12 injections and the figures won't pick up on that either. I permanently have a drink of some variety or another on the go and I'm stumped to understand it all!

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Lizzie2 on Feb 21^st, 2008, 4:55pm

I took warfarin for 4 months after having 2 blood clots in my left arm. Didn't notice any effect on my CH whatsoever. Was also on lovenox until the warfarin got into therapeutic range.

Just from my perspective on it. I did end up more anemic and had a really long menstrual cycle while on warfarin and then had to stop it for a little while. That was right at the end of the 4 months, though. It didn't have any effect on my CH or my migraine.

Thought I'd share...
Carrie

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Peppermint on Feb 21^st, 2008, 5:23pm

on 02/21/08 at 10:53:17, E-Double wrote:

E - I thought it was me. But then I'm always just a little b*tchy.

I was wondering what the hell that meant.

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Annette on Feb 21^st, 2008, 6:07pm

on 02/21/08 at 10:53:17, E-Double wrote:

This to me comes across as condescending and makes me appear to benot only uneducated but a casual bystander in our community.
I thank you posting information and for making me feel like $hit.

Eric

I didnt mean it that way and I am sorry that was how it came across to you. If that made you feel bad then I apologise.

Modified to add : what I really meant was that I was really happy to see you post on my thread Eric, because you rarely talked to me on the Board in the past. I was genuinely happy about it and I am sorry I didnt convey that correctly.

What I really should have said was " Eric was interested enough in my thread to read and add to it " . You had hardly done that before.

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Annette on Feb 21^st, 2008, 6:11pm

on 02/21/08 at 16:55:38, Lizzie2 wrote:

Thanks Carrie for sharing your experience.

There just seems to be such great response to Warfarin as reported in the 3 cases yet it didnt seem to attract much attention as in further research. I am still wondering if anyone else here is on Warfarin and whether it seems to have any effect on CH.

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Annette on Feb 21^st, 2008, 6:15pm

on 02/21/08 at 00:19:22, Ace_Sterling wrote:

The plavix made a huge difference for me and it is safer than taking warfarin in my opinion.

Thanks Ace, can you share how you thought/found Plavix making a huge difference for you ? Did you mean it helped your CH ?

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Annette on Feb 21^st, 2008, 6:29pm

on 02/21/08 at 12:14:35, nani wrote:

Annette, why choose to use your sarcasm on Eric? One of the most helpful, informative and kind members here?

I'm the one you're pissed at. 8)

I'm not really concerned about a hijack... the above links are all there is on it.

I am not concerned about hijacking either, threads go where they go and I feel its important to say that I didnt mean sarcasm and I am not " pissed" with you anymore. I used to yes but thats gone a long time ago.

I am not "pissed" ( I dont know what would be the best word to use here so I just borrow yours) with anyone here at all and thats the truth from my heart. Whether you or anyone else decide to believe differently thats your/their choice.

God knows and thats enough for me.

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by Barry_T_Coles on Feb 21^st, 2008, 10:49pm

on 02/20/08 at 18:44:59, nani wrote:

http://www.med-owl.com/clusterheadaches/tiki-index.php?page=Anticoagulants

Nanni thanks for that info it’s the sort of thing I have been looking for to explain even if only to myself just why I’m getting such good results with the Taurine/Magnesium/Calcium regime I am using.
When looking at the other things that promote blood thinning things start to fall into place; Fish Oil I love my sardine & chopped onion sandwiches & will have them at least once a week, Tomato Juice is always a morning starter & we use Olive Oil for all forms of our cooking be it BBQs basting roasts for the Webber & is the base for any salad dressing .
Perhaps it’s the combination of all these things plus the fact that I live in a region where the weather itself promotes the thinning of the blood ( winter temps 9c-25c & summer 19c – 40+c & that’s why I freeze my little but off when I go south.

Much appreciated
Cheers
Barry

Title: Re: Warfarin and refractory chronic CH - 1 case re
Post by MJ on Feb 29^th, 2008, 12:06am

Warfarin / Heparin

A small percentage of those use warfarin/Heparin treatment therapies some 450 or so have died thats only like 3%, gleaned from reading other sources.

This excerpt from medscape.

"If there's an overriding message from our study, it's perhaps that the hemorrhagic risk associated with heparinlike perioperative anticoagulation is greater than previously appreciated, and that it needs to be considered carefully in any risk/benefit analysis that one is doing around an interruption of warfarin for an elective procedure," Garcia said. "We don't have good data about the benefit of perioperative heparin, whereas we are getting increasingly more evidence that perioperative heparin certainly comes with a risk."
http://www.medscape.com/viewarticle/568916

Six weeks later just blame it on the Chinese -
http://www.reuters.com/article/healthNews/idUSN2862411220080228