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Cluster Headache Help and Support >> Medications,  Treatments,  Therapies >> Re: Will Migranol help?
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Message started by Bob_Johnson on Mar 12th, 2009 at 8:25am

Title: Re: Will Migranol help?
Post by Bob_Johnson on Mar 12th, 2009 at 8:25am
Mig not especially useful for Cluster. Action is too slow and inconsistent.

Studies support this spray:

Neurology. 2007 Aug 28;69(9):821-6.  
Zolmitriptan nasal spray in the acute treatment of cluster headache: a double-blind study.

Rapoport AM, Mathew NT, Silberstein SD, Dodick D, Tepper SJ, Sheftell FD, Bigal ME.

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. alanrapoport@gmail.com

OBJECTIVE: To evaluate the efficacy and tolerability of zolmitriptan 5 mg and 10 mg nasal spray (ZNS) vs placebo in the acute treatment of cluster headache. Design/ METHODS: We conducted a multicenter, double-blind, randomized, three-period crossover study using ZNS 5 mg, ZNS 10 mg, and placebo. Headache intensity was rated by a 5-point scale: none, mild, moderate, severe, or very severe. The primary efficacy measure was headache response (pain reduced from moderate, severe, or very severe at baseline, to mild or none) at 30 minutes. Logistic regression was used to account for treatment period effect as well as for cluster headache subtype effect. RESULTS: A total of 52 adult patients treated 151 attacks. For the primary endpoint, both doses reached significance at 30 minutes (placebo = 30%, ZNS 5 mg = 50%, ZNS 10 mg = 63.3%). For headache relief, ZNS 10 mg separated from placebo at 10 minutes (24.5% vs 10%). Zolmitriptan 5 mg separated from placebo at 20 minutes (38.5% vs 20%). For pain-free status, ZNS 10 mg was superior to placebo at 15 minutes (22.0% vs 6%). Both doses had higher pain-free rates than placebo at 30 minutes (placebo = 20%, ZNS 5 mg = 38.5%, ZNS 10 mg = 46.9%). Side effects were mild and seen in 16% of those attacks treated with placebo, 25% of attacks treated with ZNS 5 mg, and 32.7% treated with ZNS 10 mg. Conclusions/Relevance: Zolmitriptan nasal spray, at doses of 5 and 10 mg, is effective and tolerable for the acute treatment of cluster headache.

Publication Types:
Research Support, Non-U.S. Gov't

PMID: 17724283 [PubMed]

Title: Re: Will Migranol help?
Post by Ray on Mar 12th, 2009 at 10:20am
Hello Michael:

I don't wish to contradict my distinguished cluster-brother Bob Johnson, but I have used Migranol (DHE) to abort my attacks.  It was effective, but raised my blood pressure too high and severely clogged my nose for hours.

I would suggest you try one of the "triptans" available in a nasal spray.  You might want to try this in the Doctor's office as there MAY be severe side effects.

Wishing you well,

Ray

Title: Re: Will Migranol help?
Post by Marc on Mar 12th, 2009 at 10:48am
Migranol also worked quite well as a CH killer for me - once - but I had the same BP spike as you, Ray.

Zomig nasal spray (zolmitriptan on Bob's article) works very, very quickly and effectively for me IF I use it right away.

My standard approach is to apply the spray, then hit the O2. Makes the world a wonderful place.........

Title: Re: Will Migranol help?
Post by Brew on Mar 12th, 2009 at 11:26am
I used Migranol (DHE-45 spray) for a couple of years in conjunction with O2. It worked pretty well, but as Ray has stated, it stuffed me up for hours. That, combined with the hassle factor of having to break the glass vial and assemble the applicator pushed it into the "I don't think so" category for me. There's just so many other things that can work just as well (O2 alone, for example) that I figured, why bother?

Title: Re: Will Migranol help?
Post by Bob_Johnson on Mar 12th, 2009 at 1:44pm
NOW RAY!! I haven't achieved the status of God-head yet. <bg>

But curious to search PubMed and could find only one abstract on the use of the inhaler form in CH--and look at the date. Suggests this has not been a market killer!
============
Dihydroergotamine nasal spray in the treatment of attacks of cluster headache. A double-blind trial versus placebo.

Andersson PG, Jespersen LT.

Cephalalgia. 1986 Mar;6(1):51-4.

PMID: 3516408 [PubMed]

Title: Re: Will Migranol help?
Post by micheal on Mar 12th, 2009 at 8:25pm
Thanks guys. I appreciate all the info. I believe I will throw that presciption away. I dont want anything like that. I will ask him about the Zomig. I use o2, and for the hits arond 7 and below the o2 works every time, but the 8's and above, it doesn't help. I  would like something for the BAD ones other than injections. I dont know if i will have any luck, but I'm gonna keep my fingers crossed. Thanks again!

Title: Re: Will Migranol help?
Post by Karla on Mar 13th, 2009 at 7:13am
I used the imtirex nasal spray for years and it worked just as fast as the shot 6-10 min.  Just to let you know there is an alternative out there besides the zomig nasal spray.  The imtirex ns comes in 10mg and 20mg doses.  I found I could take 2 20mg a day max or 4 10 mg a day max.  The 10 mg was more than suffiencient for me to abort me ch.

Title: Re: Will Migranol help?
Post by micheal on Mar 13th, 2009 at 9:01am
I have noticed that alot of people on here use the Imetrex and seem to like it. I thought it only came in injections though. Good to hear it also comes in spray. I will talk to my Dr. about that also. Thanks for the info!

Title: Re: Will Migranol help?
Post by superhawk2300 on Mar 20th, 2009 at 9:28am
Migrinal worked great for me. Very reliable and fast acting. I did not get the stuffiness reported by other users, or I was so relieved the attack was over I didn't notice.

Title: Re: Will Migranol help?
Post by ellenjoanne on Apr 26th, 2009 at 6:11pm
+1 for me.  I'm not a fan of injections, and I wasn't injecting Imitrex (and as a result, suffering through CH attacks), so my neuro put me on Migranol as an abortive in 2006. Most of the time it works great for stopping my CH.  I tried Imitrex in nasal spray from, and it didn't work as well as the Migranal.  So, Migranl it is.  I haven't had any of the BP issues others have reported.  The only downers about Migranal for me are:

1.  Cost - even with health insurance it costs me $11/dose.  It gets mighty expensive to use when your CH is running rampant, and you're getting hit every day, and sometimes twice a day.   BTW, Imitrex nasal spray is just as expensive.

2.  You need to do 2 hits of Migranal -  after the first dose in each nostril, you need to do a second dose (each vial of Migranal contains about 2 or 3 doses worth of the med) 15 minutes later, to make sure it stops the CH attack. If it's late at night, and you're trying to get back to sleep, it can be a hassle at times staying up another 15 minutes, to take a second dose.

Ellen

Title: Re: Will Migranol help?
Post by ClusterChuck on Apr 26th, 2009 at 9:56pm

micheal wrote on Mar 12th, 2009 at 8:25pm:
I use o2, and for the hits around 7 and below the o2 works every time, but the 8's and above, it doesn't help. I  would like something for the BAD ones other than injections.


Micheal, I would be interested in hearing how you use your oxygen.  What flow rate?  What type of mask?  How long do you stay on it?

Also, where do you live?  

I use oxygen almost exclusively to abort my hits.  It does not matter if it is a KIP5 or a KIP10 ... I use it for all of them, and it is usually very effective.  I DO get some hits (not always high KIP ones) that refuse to abort with the oxygen, and then I fall back onto the Imitrex injection.

Maybe if we change how you use the oxygen, it will be your magic bullet abortive!

Chuck


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