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        New Message Board Archives >> Medications, Treatments, Therapies 2005 >> Question about Triptans
        
(Message started by: Margi on Jan 26^th, 2005, 10:20am)

Title: Question about Triptans
Post by Margi on Jan 26^th, 2005, 10:20am

Just wondering if ALL the triptans are known to cause rebounds/change of pattern like Imitrex does?

We're going to Mike's doc tonight to get prescription renewals and I'm really wondering if we should switch him from Imitrex spray to Zomig spray or.....? Any thoughts? Any other good abortive ideas out there? He's at the point in this cycle where the o2 is starting to fail as an abortive. The lithium is still helping, but the breakthrough attacks are getting on his nerves.

Thanks, folks.

Title: Re: Question about Triptans
Post by Marc on Jan 26^th, 2005, 10:46am

Margi,

I suspect that you will get opposing responses to this - I'm totally convinced that different people have different reactions to Triptans. Years ago, I copied something Ueli was doing and it worked for me - taking Amerge at bedtime (sometimes only 1/2) as a preventative for the night attacks. Yes, I said preventative.

After many months of doing this, and also sometimes taking one to abort daytime hits, I never encountered the slightest hint of rebound, or loss of effectiveness. I’ve followed this pattern many times over the last 5+ years. As you may remember from our recent email exchange, I stopped taking all Triptans back in early December – not even a hint of rebound.

I’m NOT saying that Amerge is some kind of magic bullet, it’s just another Triptan with a long half life, but for me it’s more effective than Frova and Relpax - and stays active for hours - unlike Trex, Maxalt and Zomig.

Marc

Title: Re: Question about Triptans
Post by Margi on Jan 26^th, 2005, 10:49am

Thanks so much, Marc. I'll mention this to the doc tonight.

Glad to hear your treatment plan is still working for you so well, my friend - you've definitely deserved a break from this crap!

Hugs,
Margi

Title: Re: Question about Triptans
Post by Gator on Jan 26^th, 2005, 9:48pm

The Zomig Nasal Spray worked about as well for me as Imitrex does. I have seen people post that it keeps them attack free for as long as 10 to 24 hours depending on the person.

As with everything else "your mileage may vary"

Title: Re: Question about Triptans
Post by Bob P on Jan 27^th, 2005, 9:55am

To put some rust on Marc's bullet, since we both see the same neuro, I too was prescribed 1/2 tab of Amerge twice a day as a preventative. It didn't work at all for me (as a prevent). I wound up taking it and O2 as an abortive. It did work to keep the attack from resurfacing after I stopped the O2. Then I ran into the normal insurance hassle with triptans and wound up switching to cafergot instead.

I still haven't bought into the triptan rebound thing. There are articles here about using triptans to detox from rebound causing analgesics:
http://www.clusterheadaches.org/library/medications/imitrex_rebound.htm

Title: Re: Question about Triptans
Post by JJA on Jan 27^th, 2005, 10:03am

This is just a guess, but the longer the half-life of the drug the less likely it should be to cause rebounds. This guess is based on the fact that in all classes of drugs, the ones with the shortest half-lives are always the ones with the most problems with withdrawal (a rebound is most likely a withdrawal symptom, but with CH who knows). That's why heroin addicts are given methadone and xanax addicts are given valium. Of course, there is so little known about CH and there is no real research here.

Jesse

Title: Re: Question about Triptans
Post by Bob P on Jan 27^th, 2005, 10:09am

This may help. I think the row you are most interested in is the "Recurrance". It appears that Frova has the lowest percentage of recurrance:

http://www.clusterheadaches.org/meds_triptans.htm

Title: Re: Question about Triptans
Post by Margi on Jan 27^th, 2005, 1:16pm

thanks, everyone :) Bob, I read those two articles yesterday actually. we had an appt with the doc last night and we ended up refilling the 'trex 'script.

I'm thinking Mike isn't actually getting rebounds. They are full blown cluster attacks. I think it could be just that he's at peak of cycle at the moment and we're getting some breakthroughs. The lithium is keeping them at bay though, nothing higher than a 6 he says, but he is aborting them with 'trex though, so who knows if they were destined to go higher.

Thanks for the input, everyone. And, Bob, thanks for being such a great librarian!

Title: Re: Question about Triptans
Post by Bob P on Jan 27^th, 2005, 1:48pm

The night I tried the trex tip, I was up every 2 hours re-injecting because the attack had resurfaced. I switched to taking cafergot along with the O2 when the 1 1/2 hours after falling asleep attack happened and I would sleep the rest of the night. I have read articles about using cafergot as a preventative also. I guess I go with it because it's cheap, easy to get, and it doesn't need to work fast as long as I have O2.

I may try some of the Frova with O2 next time (if there is one).

Title: Re: Question about Triptans
Post by guesst on Jan 27^th, 2005, 3:46pm

I have never had rebounds from amerge or zomig, but I have only taken them in the pill form.

Title: Re: Question about Triptans
Post by Bob P on Jan 27^th, 2005, 4:51pm

A lot of people here confuse rebound headaches with reoccurance of the cluster attack. They are different animals.

Rebound headaches feel more like tension headaches.

Title: Re: Question about Triptans
Post by guesst on Jan 27^th, 2005, 5:14pm

on 01/27/05 at 16:51:40, Bob P wrote:

A lot of people here confuse rebound headaches with reoccurance of the cluster attack. They are different animals.

Rebound headaches feel more like tension headaches.

Ok, then I have had no recurring ch's with zomig or amerge. I have with imitrex. I wouldn't know a tension headache if it bit me in the ass.

Title: Re: Question about Triptans
Post by Bob P on Jan 27^th, 2005, 6:37pm

And I've never had re-occurance from any of the tablets, Trex, Maxalt, Amerge but I did get them with trex jabs.

I've also eaten cafergot at the rate of about 25/week for months on end and never had rebounds when stopping.

I say, if it's hurtin', take a bunch of shit;
when it stops hurtin', quit takin' shit!

Title: Re: Question about Triptans
Post by Ueli on Jan 27^th, 2005, 6:42pm

on 01/27/05 at 16:51:40, Bob P wrote:

A lot of people here confuse rebound headaches with reoccurance of the cluster attack. They are different animals.

Rebound headaches feel more like tension headaches.

Bob, you must be quite stubborn ;;D

I have given up long ago to fight against the misuse of "rebound".

Title: Re: Question about Triptans
Post by Margi on Jan 27^th, 2005, 10:18pm

this one is my mistake. These attacks are happening during the day when we're both at work, so I'm not seeing them. I foolishly assumed they were rebounds until I finally asked Mike to confirm that the increased number of hits were rebounds and he told me, no, they're full blown attacks. He's so good about staying calm now when he gets hit that maybe I'm getting immune to it all. When I would see him get hit at night, he'd snort a 'trex and go downstairs to get on the oxygen until it passed. He needs to cluster alone, so I stay upstairs. Because he's so quiet, I assumed rebound. We all know what happens when we assume things. ::)

thanks again for the input folks.

we did kinda mess up with the lithium the other day and he had a bad 48 hours. But we're back on schedule now and he's had only 2 small breakthroughs today. So far, I'd give this lithium prophylactic thing a B+.

Title: Re: Question about Triptans
Post by guesst on Jan 28^th, 2005, 9:17am

When a basketball comes off the backboard and is taken by a player it is still a basketball.

Title: Re: Question about Triptans
Post by Bob P on Jan 28^th, 2005, 9:52am

Headache: The Journal of Head and Face Pain
Volume 40 Issue 1 Page 41 - January 2000
doi:10.1046/j.1526-4610.2000.00007.x

Alteration in Nature of Cluster Headache During Subcutaneous Administration of Sumatriptan
Rachel Hering-Hanit, MD
Objectives.To document the relationship between the 5-HT receptor agonist sumatriptan and a change in the nature of cluster headache in four cases. To relate the findings to the literature on the use of sumatriptan in both cluster headache and migraine.

Background.Studies of the efficacy and adverse effects of long-term treatment with sumatriptan in cluster headache are limited and report conflicting findings.

Methods.Four cases are described.

Results.All four patients developed a marked increase in the frequency of attacks 3 to 4 weeks after initiating treatment with the drug for the first time. Three patients also developed a change in headache character, and 2 experienced prolongation of the cluster headache period. Withdrawal of the drug reduced the frequency of headaches and eliminated the newly developed type of headache.

Conclusions.Determination of the effects of long-term use of sumatriptan will result in more precise guidelines for the frequency and duration of treatment with this otherwise extremely beneficial drug.

Title: Re: Question about Triptans
Post by Margi on Jan 28^th, 2005, 9:54am

yep, Bob, that could very well be the case here. But I gotta wonder if this also applies to the inhaled triptan. I tend to think inhaling it isn't quite so invasive as injecting it. Wonder if it makes a difference?

Title: Re: Question about Triptans
Post by BikerBob on Jan 28^th, 2005, 3:33pm

Quote:

The night I tried the trex tip, I was up every 2 hours re-injecting because the attack had resurfaced.

Me too. Exactly.

When I used a full trex injection for 1am hits I would get another hit at 5am or 6am.

When I use a trex 100mg tablet or Zomig ZMT for 1am hits there is no reoccurrance until the following evening.

Bob