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        New Message Board Archives >> Jul-Sep 2003 >> rebound headachs
        
(Message started by: msharrar on Jul 24^th, 2003, 8:43pm)

Title: rebound headachs
Post by msharrar on Jul 24^th, 2003, 8:43pm

hi all........ new here, but old to CH........Question...can someone please explain about rebound headachs......and what medications can cause them!!!

Title: Rebound headaches.
Post by Bob_Johnson on Jul 25^th, 2003, 5:35am

From an earlier message I posted:

Rebound headaches. "Rebound Headaches--A Review", Au. John S. Warner, M.D., in HEADACHE QUARTERLY, 10:3(1999). (There is some confusion on the board about the meaning of "rebound". There appears to be an emerging consensus in the medical literature to define "rebound" as a headache which is caused by the overuse of any medication used to abort a headache or relieve pain. "Recurrence" [of a headache] is being used to refer to the redevelopment of an attack when its "normal" duration is longer than the useful life of the medication which has been taken. That is, the medication effectiveness is reducing before the headache has come to an end; the pain redevelops.)

Title: Re: rebound headachs
Post by catlind on Jul 25^th, 2003, 6:43am

Rebound headaches are not that easily defined.

I will only address the points I know from Dr. Bigal. Their studies at the New England Headache Center have shown decisively that imitrex used as an abortive in a clusterhead will NOT cause 'rebound' headaches. That is to say that you will not have a frequency in attacks, or develop daily headaches aside from clusters. This is the overall picture, and there will always be some who do.

HOWEVER, and it's a big however, if you have migraine in conjunction with your CH, using imitrex should be done according to the max daily dose, and use of it for more than 10 days WILL cause rebound headaches and you will eventually develop daily headaches.

So if you suffer from clusters and have other type headaches as well, you should be cautious in your use of imitrex, however, Dr. Bigal pointed out that it is your docotos job to treat the rebound headaches as well as the clusters, and that none of us should have to suffer the pain of CH just because a rebound headache is possible. They are supposed to be treating us for both problems, CH, and rebounds.

Cat

Title: Re: rebound headachs
Post by ozzman on Jul 25^th, 2003, 7:38am

Ok, here is the confusing part. Last night talking to Randy and Joe, they had mentioned what Dr. Bigal said at the conference with rebounds from Imitrex. However, my understanding from previous research (found in the OUCH site) is the following:

Quote:

Daily Sumatriptan for Detoxification From Rebound
Peggy Drucker, Stewart Tepper, MD

Abstract
Medications which provide symptomatic relief from headache can transform episodic migraine into chronic daily headache by propagating the daily headache, causing "rebound." It is possible to restore the episodic migraine pattern by using an inpatient course of intravenous dihydroergotamine.

This study was undertaken to explore whether it was possible to use oral sumatriptan in the outpatient setting as a bridge to detoxification for patients with chronic daily headache due to medication overuse. All patients had previously met International Headache Society (IHS) criteria for episodic migraine and currently had greater than 15 days of headache per month for greater than 1 month. These patients were advised to take 25 mg sumatriptan by mouth three times a day for 10 days or until they were headache-free for 24 hours.

Results reveal that of the 26 patients who started the protocol, 58% had reverted to an episodic migraine pattern at 1 month, and 69% were no longer having chronic daily headache at 6 months. This study demonstrates that it is possible to detoxify patients with rebound headaches using oral sumatriptan during the withdrawal period in an outpatient setting

So folks which one is it? I smell more research coming....

Ozzy

Title: Re: rebound headachs
Post by catlind on Jul 25^th, 2003, 7:54am

It is exactly that Ozzy. In episodic and chronic migraine sumaptriptan injections WILL cause rebound and daily chronic headaches, if you are a CH sufferer, and do not suffer from other headache types, sumaptriptan injections will NOT cause rebound or daily chronic headaches. Please remember that when I say they will, we are talking about daily use of trex, not occassional use. CH'ers don't take meds once a day, or 2 days a week, we take multiple doses every day for a lengthy period of time (according to IHS standards for lengthy)

The catch is that alot of us have both migraine and CH. That then leaves us having to deal with daily chronic headache, but it is Dr. Bigal's feeling, that it is the job of our doctors to then treat the daily rebound headache, without halting treatment of CH.

This is where treatment with the pill form of sumatriptan may help daily chronic headache. The how of helping a CHer through rebound is going to be individual to each doc that treats us, but it is their job to treat BOTH problems, and not to abandon one treatment to avoid the other scenario.

Is that more clear? Not sure if I'm getting my wording right here so that you can see the difference. Let me know :)

Cat

Title: Re: rebound headachs
Post by ozzman on Jul 25^th, 2003, 8:15am

Cat,
I'm I read and read and re-read both the article and your answer and it may very well be that we are arguing the same thing but from different perspectives. But what I read from the article is that oral trex at 75mg a day for 10 days, can actually break the cycle of rebounds (chronic daily headache).

.....I' ve been stuck looking out the window for the last 20 min. trying to find a way to put the two findings together to something that makes passable sense. But I can't and now my head hurts :)

Thank you Cat for your quick response.

Ozzy - not trying to pick an argument, really..

Title: Re: rebound headachs
Post by catlind on Jul 25^th, 2003, 8:22am

LOL no worries, I am not interested in picking an argument either! I see exactly where the discrepancy lies, and I did not put enough emphasis on the fact that I was discussing sumatriptan INJECTIONS.

As far as I know, Dr. Bigal was only discussing the injection form, as CHers, the pill form is not an effective or CH labeled med for us. It is far to slow acting.

So there lies the difference :) If you are using daily multiple INJECTIONS of sumatriptan, and you suffer other headache types besides CH, you will likely encounter rebounds. If you ONLY suffer CH, you will not (on the whole) suffer rebounds. The sumaptriptan pill is one form of treating the rebound headaches that come from the injection usage :)

Does that make more sense now? The injection form and the pill form really are that different apparently.

Cat

Title: Re: rebound headachs
Post by msharrar on Jul 25^th, 2003, 10:53am

thx for the replies......im male ,38,been having clusters since i was 19.....until this bout that started a month ago i never really had chronic daily headaches,but for some reason im getting like 4 full blown knockouts a day.....i find zomig works amazingly, but its only effective for the first 2 headaches of the day and then im left in a terrible limbo wondering when and where the third one will kick in....ive tried everything drug wise....im on verapimil...predisone.....neurotonin...amitriptline...percodan...oxycontin....zomig..... imitrex.......
ive never been in so much pain.....how can u not think of suicide.....

ive been told of the dangers of rebounders but i thought or was led to believe that it was attributed to aspirin use or overuse......anyhow....i havent taken any aspirin in 4 days so i doubt im rebounding......i figure im getting just one headache a day and the zomig isnt completely knocking it out so it comes back as the zomig wears off.....i have a very sever horners syndrome that has gone perminant, even when im not in pain from the clusters i still get constant pain from the muscle around my left eye and all the kings doctors and neuro's cant explain that one......im just losing it.....a little more each day and wondering how much longer

Title: Re: rebound headachs
Post by ozzman on Jul 25^th, 2003, 11:03am

Welcome to the borad msharrar. The first thing you will find here is that you are NOT alone. There are many like you that try different combos of meds until they find something that works. My suggestion is to drop the narcotics since they don' t do squat for CHs. Talk to your Doc, about it so he can do it safely (some can't just be quit cold turkey) then... try different triptans and in different forms. Last but not least, try oxygen. I was skeptical at first, let me tell you what, IT WORKS!!!
Don' t despair, as I said before, you are not alone!

PF vibes to you.

Ozzy

Title: Re: rebound headachs
Post by Peppermint on Jul 25^th, 2003, 11:14am

Ozz, the article says episodic migraines. The factor which will make a difference in rebounds or not will be whether they are Migraines or Clusters. Cat said it well, and Dr. Bigal answered that question - to differentiate who will get rebounds from imitrex. If you get migraines AND clusters, then the rebounds are possible. In which case you'd have to be treated for the rebounds as well.

Otherwise, as a cluster sufferer only, imitrex is not an issue. That is what I understood.

Title: Re: rebound headachs
Post by msharrar on Jul 25^th, 2003, 11:25am

i know the narcotics dont help the pain at all.......BUT.....in between clusters i cant explain the way i feel....its like depression and anxiety and no energy....i cant move, my whole body hurts to touch....i havent been able to work for a month now....we r self employed and my wife has been working 17hr days 7 days a week......the oxycontin is the only thing ive found that gets me on my feet again(between headaches).....some nights it gets so bad i have to go to the emergency room on account that im dehydrated from vomiting(not from the oxycontin)....the first times they tried oxygen but i found it aggravated my condition....the cold oxygen running up my nose felt like inhaling slivers of glass

Title: Re: rebound headachs
Post by Peppermint on Jul 25^th, 2003, 12:04pm

msharrar,

If you are trying 02 and it is uncomfortable (I'm sure that's an understatement), maybe you should try using it with a bubbler. The bubbler will hydrate the 02 which may relieve the discomfort of the dry air you are breathing.

Read up on 02 and how to use it here: http://www.maplefallswebdesign.com/misc/oxygen/oxygen.htm

Title: Re: rebound headachs
Post by Mark C on Jul 25^th, 2003, 5:48pm

"The results show that the overall incidence of adverse events among patients receiving sumatriptan injections for the treatment of cluster headache is low. The extended administration of this drug in episodic cluster headache did not result in tolerance problems or tachyphylaxis. Only 4 patients experienced minor adverse events and recovered more slowly than the others."

Look here. (http://www.clusterheadaches.org/library/medications/imitrex_rebound.htm)