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        New Message Board Archives >> Medications, Treatments, Therapies 2005 >> Cafergot Question?
        
(Message started by: burnt-toast on Jun 7^th, 2005, 7:44pm)

Title: Cafergot Question?
Post by burnt-toast on Jun 7^th, 2005, 7:44pm

Recently added Cafergot to my daily med consumption. For reference now at:

200mg Cafergot
720mg Verapamil
1,200mg Lithium (just increased from 900mg)
9mg Melatonin

Still not getting relief but my clusters are starting 1.5 to 2 hours earlier in the evening. Also getting shadows throughout the day - something not experienced in the past.

Anyone have similar experences? I'm about to chuck the Cafergot before it makes things worse.

Title: Re: Cafergot Question?
Post by Kris_in_SJ on Jun 7^th, 2005, 8:18pm

Hi,

In answer to your question ... I've never known any clusterheads to be helped by Cafergot. Never tried it myself. I'm strictly an Imitrex inject, Verapamil (high dose), Melatonin, and sometimes Prednisone taper kind of girl.

Ergotomine drugs are usually pretty effective for migraine sufferers, but clusters are another type of animal altogether.

Did I help at all?

Kris

Title: Re: Cafergot Question?
Post by burnt-toast on Jun 7^th, 2005, 9:31pm

Kris_in_SJ,

Thanks for the prompt response, and yes you helped. You are absolutely correct - it is primarily a migrane treatment but is somtimes used to treat clusters. Particularly those not responding to other meds. Seems to be the norm for cluster treatment - attempt using drugs meant for something else. Just hoping someone else had experience using itl

Just a little strange that since taking it my cluster timing and overall symtoms went out of wack. Not sure if that is good or bad at this point. Things haven't changed for me for some time now, years actually.

Title: Re: Cafergot Question?
Post by E-Double on Jun 7^th, 2005, 9:40pm

Bob P takes cafergot......contact him!

Title: Re: Cafergot Question?
Post by BlueMeanie on Jun 7^th, 2005, 9:59pm

Cafergot never worked for me. They used to give it to us way back in the day. You never mentioned any abortive meds. What about 02 ? Have you tried triptans ? If you have a problem with blood pressure, heart, circulation etc., they may not be the right choice for you. Check with your med professional. There are other possibilites that work for many both as prevents and abortives. I personally have never found a prevent to work and stopped taking them many years ago. Have you read the Kudzu thread. It seems to be pretty good as a prevent. Definately read up about 02.

Anyhow, good luck to you and I hope you find something that works.

Title: Re: Cafergot Question?
Post by burnt-toast on Jun 7^th, 2005, 11:00pm

E-Double - Thanks, as soon as I make time to learn how to ring up someone directly, I'll try Bob P.

BlueMeanie - Thanks for the info. on Cafergot. - My intro.

10 year sufferer, primarily chronic - About 9 mos. pain free in 10 years.

Treatment - Endless tests, 1 bad and 2 good Neurologists/familiar with clusters - Meds - Lithium (1200Mg daily), Verapamil (720Mg daily) Melatonin (9Mg at bed). Been up and down on dosages not getting relief. (now added 200mg Cafergot).

Oxygen, Imitrex and Zomig - not effective during attacks. Recently completed high dose steroid therapy - not effective.

Lookin for relief in all the wrong places.

I'm just starting to go through the Kudzu thread and others that kind folks like yourself have pointed me to.

Thanks

Tom

Title: Re: Cafergot Question?
Post by bnfreeman on Jun 7^th, 2005, 11:11pm

The first time I used the Cafergot it kind of worked. But after that I think it just made things worse. My doctor had me on it not to long ago when I was shadowing everyday just about all day and it didn't help. But I think he was using it to break the cycle. Everyone's different though.

BF

Title: Re: Cafergot Question?
Post by Lizzie2 on Jun 7^th, 2005, 11:42pm

I think since the advent of the triptans, it isn't even found commonly prescribed in migraine therapy anymore. I've never tried it, but I do know people who have at some point.

I know by now I can't remember all the details, but one of my dad's best friends lives up the street from us and started getting CH when he was in college or law school. I think how it went was that he was chronic from the start for 9 straight years until in 1980 they just up and went away. He feels very fortunate! :) I do know that the only med they were really trying him on was cafergot...but honestly I don't even remember if it was a great help or not! (Obviously I'm not much help...lol)

At any rate, I know it used to be prescribed a lot more often prior to some of the newer abortives out there, and I'm sure some docs still turn to it when other things are not helping their patients.

I hope you find something that helps.

L2 :)

Title: Re: Cafergot Question?
Post by burnt-toast on Jun 8^th, 2005, 12:48am

Lizzie2

Every little bit of information is helpful. We're all looking for the same outcome - relief.

Cafergot my be a last ditch effort by my neurologist to find something that works - along with the script he handed me information on surgical procedures for discussion at my next visit. I've been attempting to get prepared for that and folks here have helped with direction and information.

I should have signed on years ago instead of dealing with it on my own.

Thanks

Tom

Title: Re: Cafergot Question?
Post by bnfreeman on Jun 8^th, 2005, 5:49am

I heard that recovery from the surgeries can be worse than the clusters themselves. And none of them are guaranteed. Look back through the old posts and read up on it more. Best wishes, BF

Title: Re: Cafergot Question?
Post by Bob_Johnson on Jun 8^th, 2005, 9:04am

Works for some of us. You will know, with 1 or 2 uses, whether it helps. Your doc can give you a sample.
---------------
1: Headache 2001 Sep;41(8):813-6

Olanzapine as an Abortive Agent for Cluster Headache.

Rozen TD.

Department of Neurology, Jefferson Headache Center/Thomas Jefferson University Hospital, Philadelphia, Pa.

OBJECTIVE: To evaluate olanzapine as a cluster headache abortive agent in an open-label trial. BACKGROUND: Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs. METHODS: Olanzapine was given as an abortive agent to five patients with cluster headache in an open-label trial. The initial olanzapine dose was 5 mg, and the dose was increased to 10 mg if there was no pain relief. The dosage was decreased to 2.5 mg if the 5-mg dose was effective but caused adverse effects. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose. RESULTS: Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and two patients became headache-free after taking the drug. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness. CONCLUSIONS: Olanzapine appears to be a good abortive agent for cluster headache. It alleviates pain quickly and has a consistent response across multiple treated attacks. It appears to work in both episodic and chronic cluster headache.

--------------------------------------------------------------------------------

Olanzapine has a brand name of "Zyprexa" and is a antipsychotic. Don't be put off by this primary usage. Several of the drugs used to treat CH are cross over applications, that is, drugs approved by the FDA for one purpose which are found to be effective with unrelated conditions--BJ.

Title: Re: Cafergot Question?
Post by Bob P on Jun 8^th, 2005, 9:34am

I've used cafergot during my cluster cycles for the past 30 years. Used tablets, inhaler and sublingual tabs (not sure they make the last two anymore). It is an old drug. A non-specific vaso-constrictor. It will close down all of your blood vessels unlike the newer triptans which target the vessels in the head.

I think you have your mg wrong. 200mg would probably kill you. It's usually 1 or 2 mg per tablet.

You're not supposed to use more than 6/day or 10/week. I've never used more than 4/day but I have gone as high as 25 in a week. Definately get cold fingers and toes at that level due to decreased circulation. It freaks the doctors out and I probably am risking ergotism at that level. This cycle I haven't gone higher than 14/week and usually less than 10.

O2 is my main abortive but frequently the headache will return in 1/2 hour to 1 hour. That's where the cafergot comes in. At the start of an attack I take a tab of cafergot and then hit the O2. O2 kills it in 10 minutes and the cafergot keeps it from coming back for at least a few hours. As the cycle falls into a pattern, I know which will be the bad hits that require cafergot and which I can handle with O2 alone.

The upside of cafergot is that it's cheap and the insurance doesn't hassle me about it. Downside is that it takes 20 minutes to kick in and if you take too much you could be in big trouble. Also, if you take it for extended periods it can cause rebound headache when you stop. Believe me, if the triptans didn't increase the frequency of attacks for me I'd take them over cafergot.

I have seen some medical articles that mention taking cafergot twice a day as a preventative but that doesn't work for me.

My only advice is that if you are taking it, keep an eye on your finger and toenails to make sure they stay nice and pink, not blue! If they turn blue, stop taking it immediately and see you doctor. You're on the verge of ergotism (St. Anthony's Fire) and risking gangrene.

Title: Re: Cafergot Question?
Post by burnt-toast on Jun 8^th, 2005, 12:02pm

bnfreeman - I'm reveiwing a lot of surgical information most of it is not encouraging and some of it very new. I'm going to keep researching, thanks.

Bob_Johnson - Olanzapine is a new one for me. I'll look into it and discuss it with my neurologist. By the way nothing surprises me anymore when it comes to CH meds. and what they were developed for - sometimes scares me though. (I want to do the Botox thing - May not feel better but looking better couldn't hurt ;;D ). I shouldn't joke, I understand it's helped some folks.

Bob P - You would think that I could read a prescription by now.

You're right I'd be pushin up little BLUE daisys at 200mg.

2mg Ergotamine with 200mg Caffeine = My Cafergot.

It was prescribed as a preventative and so far seems to be an adjstment-ative. I'll see how this goes and keep and eye out for problems but from information you provided my dosage is low.

So far the abortives I've used have been wasted money so I ride em out by keeping the floors polished between the laundry and living room. Maybe the Olanzapine will help.

Thanks all,

Tom

Title: Re: Cafergot Question?
Post by Lizzie2 on Jun 8^th, 2005, 12:36pm

Even if not pushing ergotism with that reduced blood flow to the extremities - watch out for any problems if you have other conditions that can lead to peripheral vascular disease or if you suffer from Reynaud's Disease. Reynaud's phenomenon differs from the disease in that it looks just like the disease but occurs in someone who doesn't have the full blown disease.

Briefly coming to mind - diabetes, hypertension, renal problems are big ones that can lead to forms of peripheral vascular disease.

If your hands change colour in the cold weather (typically joked about as red-white-blue), then you may want to check about Reynaud's with your physician. Rheumatologists (and probably cardiologists) are the most knowledgeable about that one, but in short form, you shouldn't need to go to a specialist unless it is a persistent problem, without the cafergot.

LOL there we go...I gave some information that wasn't useless ;) (At least I hope...)

As far as botox - before I had clusters I did that 3 times. The first time, it did wonders for my chronic daily migraine for a little while. The second time, right when it should have been kicking in, I had a figure skating accident and got a concussion with neck sprain - don't even think botox could be enough to prevent pain from that little incident! Third time - no effect. It's worth trying (especially if you have a lot of muscular involvement with your headaches...tensing up muscles which can lead to increased pain), but can be costly...not just the drug, but also the doctor's fees if your insurance won't cover either part. I was fortunate enough for my doctor to have me receive it during times when they were doing 'demonstrations' for other physicians - the medication was free for those - just had to pay for the treatment.

Oh...and olanzapine (Zyprexa) - another one just to be careful with if you have diabetes (or even a family history) - I took it for awhile (again, pre-cluster). Not a bad med - can make ya sleepy and give you dry mouth - but all in all, it wasn't the worst thing I'd ever taken. ;)

L2 :)

Title: Re: Cafergot Question?
Post by broomhilda on Jun 8^th, 2005, 1:44pm

As with all meds if you have an underlying medical condition you must be careful, with Raynauds disease any med can be an issue but I know personallly I have been warned, NO ERGOTS

Info on Raynauds

http://www.nlm.nih.gov/medlineplus/raynaudsdisease.html

Title: Re: Cafergot Question?
Post by burnt-toast on Jun 9^th, 2005, 1:57am

Lizzy2, -

Other than the clusters, I don't have any underlying conditions but will keep alert to problems. My prescription drug reference don't mention the condition so I'm looking for new ones.

I'll admit it's been some time since I took the initiative to research treatments. Was just surprised at all the references to Botox. Seems like a weird treatment until you think about where it is typically injected.

Broomhilda -

Sound advise for everyone here - given all the meds. we try and use. I weighed in with simular advise on the Novocaine post - regarding drug interations between Novocane and Lithium. It is just as important to consider medical conditions when choosing meds.

Thanks for the input.

Tom

Title: Re: Cafergot Question?
Post by ozzy on Jun 9^th, 2005, 2:00pm

on 06/08/05 at 09:34:15, Bob P wrote:

Downside is that it takes 20 minutes to kick in and if you take too much you could be in big trouble.

Back in the day before triptans, I used to take Cafergot and Cafergot PB (with a phenobarbital, which creates dependance, so I used only regular after the first few weeks)

Anywho, I found the 20 min action time kinda useless, 10 more mins (most of the time) and the CH was gone. So I figured that there had to be a faster delivery method (I was 16 at the time) I found out that if I put the tablet under my tongue and let it dissolve, it would be absorbed much faster. It worked every time within 5 to 10 mins. The downside to quote Bob again was that it tasted nasty (ha! people complain about the taste of Imitrex NS...LOL) and it gave me pronounced nausea. I managed to abort quite a few CHs with cafergot. When my prescription was running low, I would try 1/2 a tablet and even a 1/4. 1/2 worked, 1/4 not so much. This method worked for me for 5-8 years, then cafergot stopped working.

So if cafergot, works for you, do what works. One caution, same as with Triptans, DO NOT mix Ergots and Triptans, wait 24 hours. Those have been long 24 h that I've had to wait, whenever I wanted to try Cafergot again......

Good Luck,

Ozzy

Title: Re: Cafergot Question?
Post by Bob P on Jun 9^th, 2005, 4:46pm

What I'd really like to know, and can't find anywhere, is what is the half-life of cafergot? How long does it stay in your system?

Title: Re: Cafergot Question?
Post by burnt-toast on Jun 9^th, 2005, 9:56pm

The Cafergot Me

Hey all, thanks for all the assistance and information but I'm officially off the Cafergot.

Hands, forearms, legs and feet went numb and against all information regarding potential problems - got warm and red. Arteries and veins in forearms and hands bulged as well. First bad drug reaction I've ever had.

Wasn't helping much so far anyway. I really appreciate everyone's input.

Tom

Title: Re: Cafergot Question?
Post by burnt-toast on Jun 9^th, 2005, 10:19pm

Bob_P

On the half life question, I'm looking for some updated and complete prescription drug references for the medical community.

I've been using outdated references and online souces to research medications. Can't find many of the meds. I've been hearing about here in my references and online sources have been weak at best. Hopefully I'll be able to help if someone else doesn't come back with an answer.
Tom

Title: Re: Cafergot Question?
Post by ozzy on Jun 10^th, 2005, 9:33am

Bob,

from RxMed:

Quote:

CAFERGOT®
Novartis Pharmaceuticals
Ergotamine Tartrate - Caffeine
Migraine Therapy

Action And Clinical Pharmacology: Ergotamine is an alpha adrenergic blocking agent with a direct stimulating effect on the smooth muscle of peripheral and cranial blood vessels; it produces depression of the central vasomotor centers. Its properties also include serotonin antagonism. In comparison to dihydrogenated ergotamine, the adrenergic blocking actions of ergotamine tartrate are less pronounced and vasoconstrictive actions are greater. The addition of caffeine to ergotamine tartrate facilitates the absorption of ergotamine when administered orally or rectally, resulting in a more rapid onset of the vasoconstrictive effect and an increase in effectiveness. The migraine attack will be aborted in over 80% of the patients as long as the medication is taken early enough in the course of the attack.

Ergotamine is rapidly and incompletely (approximately 62% of the oral dose) absorbed by the gastrointestinal tract. Peak plasma levels are reached about 2 hours after ingestion. Ergotamine is extensively metabolized in the liver. The bioavailability of unchanged drug is about 2% when the drug is administered orally and 5% when it is administered by the rectal route. It has been suggested that the therapeutic effects of the drug are partially due to active metabolites. Protein binding amounts to 98%. Parent drug and metabolites are mainly excreted with the bile. Their elimination from plasma is biphasic with a half-life of 2.7 hours and 21 hours, respectively.

Caffeine is rapidly and almost completely absorbed; it is to a large extent metabolized. The metabolites are mainly excreted in the urine. Plasma elimination half-life is about 3.5 hours, protein binding 35%.

Draw your own conclusions (too many puns and jokes come to mind, bot those are in the Don realm....)

Ozzy

Title: Re: Cafergot Question?
Post by Bob P on Jun 10^th, 2005, 9:42am

Thanks Ozzy. Don't know why I didn't see that since I use RxList also. For burnt toast the link is:
http://www.rxlist.com/

That info pretty much tells me cafergot isn't doing much. Last night, case in point. Got hit at 11:30 and used O2. Hit at 1:30 and used O2 and a tab of cafergot. According to Ozzy's info, the cafergot should have been at peak plasma level 2 hours later. Well at 3:30 I got hit again.

Title: Re: Cafergot Question?
Post by ozzy on Jun 10^th, 2005, 9:59am

Actually Bob, it is RXMed not List.

I just googled Cafergot Half Life, and voila!

Ozzy

Title: Re: Cafergot Question?
Post by burnt-toast on Jun 11^th, 2005, 8:18pm

ozzy, Bob P -

Checked out rxmed and it is an outstanding online med. reference source. Well beyond anything I had found.
Clearly will be very helpful when considering potential meds. in the future.

Thanks for direction.

Tom

Title: Re: Cafergot Question?
Post by bruceg on Jun 20^th, 2005, 3:18pm

on 06/07/05 at 19:44:19, burnt-toast wrote:

Anyone have similar experences? I'm about to chuck the Cafergot before it makes things worse.

Egotimines are usually thought of as an abortive not a preventative...that being said:

I've used sublinqual ergot as an abortive...response is usually good if caught in time (at the first sign of a CHA)...have tried Cafergot orally by the time delay make its effectiveness dubious, somewhat more effective if used sublingually but tastes awful).

Tried one before bedtime...mixed results. If any effect, it simply lowers the intensity of the attacks...so, IMO, its not worth the side-effects.

Title: Re: Cafergot Question?
Post by burnt-toast on Jun 21^st, 2005, 11:27am

bruceg

As I discovered from feedback to this post - Cafergot can be prescribed as either Abortive or Preventative.
It was prescribed in this case as a Preventative. - End result was a bad reaction and I've stopped taking it.

Thanks

Tom

Title: Re: Cafergot Question?
Post by maryo on Jun 25^th, 2005, 10:06pm

Hi,

I use and like Cafergot as an abortive. I prefer it to Imitrex -- cheaper and doesn't give me palpitations the way Imitrex does. I will keep them by the bed and chew one up at the first sign of a cluster, use relaxation techniques to keep the pain intensity at a minimum, and be dozing off in about 20 minutes. The down side is rebound from the caffeine, a good reason not to use it prophylactically. I also have Migranal nasal spray -- pretty fast acting. Fortunately, kudzu seems to be keeping the clusters at bay for the moment -- or perhaps it's just luck.

Maryo

Title: Re: Cafergot Question?
Post by Cooked Brain on Jul 5^th, 2005, 7:40pm

Ergotamine worked for me (scripted by GP) before switching to verapamil (by neuro). The latter told me it was a very heavy med. The deseril pills were only 1mg, and I took 2 a day. 200mg seems an awful lot to me :o

Title: Re: Cafergot Question?
Post by burnt-toast on Jul 5^th, 2005, 9:24pm

on 07/05/05 at 19:40:04, Cooked Brain wrote:

Thanks,

That error was discovered early in this thread by Bob P - it was corrected to 2mg Ergotamine with 200mg Caffeine = My Cafergot

Bob P correctly pointed out that 200mg Ergotamine would be lethal.

Due to a bad reaction - I stopped taking Cafergot.

Tom

Title: Re: Cafergot Question?
Post by Cooked Brain on Jul 7^th, 2005, 6:35am

on 07/05/05 at 21:24:12, burnt-toast wrote:

sorry, missed that one [smiley=laugh.gif]

Title: Re: Cafergot Question?
Post by burnt-toast on Jul 7^th, 2005, 7:02am

on 06/20/05 at 15:18:30, bruceg wrote:

Egotimines are usually thought of as an abortive not a preventative...that being said:

Although primarily used as an abortive, Caffergot is frequently referenced as being used as a preventative - primarily for treating chronic patients.

Not sure that the side effects are any worse than other meds. being prescribed i.e. Depakote - which many tolerate but the potential for letal results with short or long term use are disturbing.

Tom

Title: Re: Cafergot Question?
Post by jcmquix on Jul 7^th, 2005, 9:30am

Tom,

I am using the Depakote ER 250mg 3x a day, as you know (I think).

Well all started off good and well, I started last thursday and 2x a day for 2 days, then I went to 3x a day after that.

As of yesterday, it kinda quit working. The BEAST has found its way around it. It never did shake the 1am hit, then yesterday I started getting bad shadows at work.
I called to Dr and I am going in today, I am going to ask for something different.

Today, after the hits last night, I am sore today and I have sort of a bad Shadow. I know its not the TREX, I only used 2ml TREX inj in the last 24 hrs.

Basically it just wore off before it actually started to work, I think the BEAST knows all about this Prevent. :(

PFDAN's to ALL !!! [smiley=headbanger.gif]