well about two weeks ago i was told i have avn, in the hips. Avascular Necrosis, which means my hip joint has lost shape and is deteriorating and dieing. i'm 24 this is a disease for old people like in their 50's or later

doctors first had me on predisone and when that stopped working they put me on dexamethasone

these are great drugs as the keep headaches away and thats what we all want, but doctors for somereason do not mentiuon about necrosis until it happens

i can barely walk, my hips ache, other muscles and joints hurt becasue of my new found limp, yea i was headache free for seven months good for me until my hips started hurting. now i have my ch's back and some wonderful hip pain. not to mention the thought of hip replacement, not being able to run, jog, rollerblade, riding a bike is even uncomfortable. stairs are my worst enemy, its a b**** to put on shoes and socks, getting comfortable when going to bed is a new hassle

so needless to say if your taking steroids, long or short, ask your doctor about prevention and early detection of avn its not fun and it can happen to you. i know we all ay we will do anything to rid of the headaches but this is not the way, they will come back accompanied by new pain

not to mention they give you hydrocodone and darvocet for the pain in your hips. yes wonderful narcotics to trigger clusters, so my hip hurts lets move the pain to my head

if i had any idea of this i would have never takin steroids, a single dose pack? no way these headaches and meds are slowly destroying my life

i got an nsaid drug for my hips wich helps alot, too bad its side effects are increased risk of heart attack and stroke, just like my imitrex shots

im 24 but i feel like im 75

so beware very aware, its a silent disease, u can have it and not know it, and if it effects one hip it will get the other, or knee, ankle, shoulder, any joint

be safe and be aware my friends dont let the same mistake happen to you in your fight against these god awful headaches

just for show heres a picture from my mri after i was complaining of hip pain notice the irregularity inside the red circles, yes those are my hips, just 24 years old

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Unfortunately, it's too late to get into much of a discussion of the use of Pred. beyond noting that current use for CH is limited to about 10-days to rapidly break a cycle. BUT then a long term preventive would have been started at the same time one started the brief use of Pred.

The data about safety with triptans is clear. There is no real risk of stroke/heart disease. That was a concern during the early introductory period but has been resolved.
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Neurology. 2006 Oct 10;67(7):1128-34. [Publisher's note: information  correct as of 1/27/09.]
Risk of ischemic complications related to the intensity of triptan and ergotamine use.

Wammes-van der Heijden EA, Rahimtoola H, Leufkens HG, Tijssen CC, Egberts AC.

Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands.

OBJECTIVE: To investigate whether the intensity of triptan and ergotamine use, in specific overuse, is associated with the risk of ischemic complications. METHODS: We conducted a retrospective nested case-control study using data from the PHARMO Record Linkage System. All patients with more than one prescription for either a triptan or ergotamine were initially identified. Cases were all patients who were admitted to the hospital for an ischemic complication. Matched controls were assigned the same index date as the cases. The determinant was the intensity of use of triptans and ergotamine during 1 year preceding the index date. OVERUSE WAS DEFINED AS USE OF > OR =90 DEFINED DAILY DOSES DURING THAT YEAR. Conditional logistic regression was used to estimate odds ratios (ORs), adjusting for confounders. Stratified analysis was used to estimate the risk for both patients using and those not using cardiovascular drugs. RESULTS: A total of 17,439 patients received more than one prescription. A total of 188 cases and 689 controls were identified. Triptan overuse was not associated with an increased risk of ischemic complications (OR 0.96; 95% CI: 0.49 to 1.90). Overuse of triptans in patients concomitantly using cardiovascular drugs did not increase this risk. Overuse of ergotamine turned out to be a risk factor for ischemic complications (OR 2.55; 95% CI: 1.22 to 5.36). Patients overusing ergotamine and concomitantly using cardiovascular drugs were at highest risk (OR 8.52; 95% CI 2.57 to 28.2).

CONCLUSIONS: IN GENERAL PRACTICE, TRIPTAN OVERUSE DOES NOT INCREASE THE RISK OF ISCHEMIC COMPLICATIONS. OVERUSE OF ERGOTAMINE MAY INCREASE THE RISK OF THESE COMPLICATIONS, ESPECIALLY IN THOSE SIMULTANEOUSLY USING CARDIOVASCULAR DRUGS.

PMID: 17030745 [PubMed ]
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Title: Triptan safety--latest statement
Post by Bob_Johnson on Jun 1st, 2004, 9:47am
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Since this is a report on medications and not on the condition being treated, I believe it would be O.K. to apply these findings to folks with Cluster. NOTE: there are no comments about using triptans at the high/multiple dosing which is often done by cluster patients. (Treat everything below the line as a quotation. These are selected para. from the total report.)
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Consensus Statement: Cardiovascular Safety Profile of Triptans (5-HT1B/1D Agonists) in the Acute Treatment of Migraine

Headache 44(5):414-425, 2004.

Posted 05/25/2004
Abstract
Background: Health care providers frequently cite concerns about cardiovascular safety of the triptans as a barrier to their use. In 2002, the American Headache Society convened the Triptan Cardiovascular Safety Expert Panel to evaluate the evidence on triptan-associated cardiovascular risk and to formulate consensus recommendations for making informed decisions for their use in patients with migraine.
Objective: To summarize the evidence reviewed by the Triptan Cardiovascular Safety Expert Panel and their recommendations for the use of triptans in clinical practice.
Participants: The Triptan Cardiovascular Safety Expert Panel was composed of a multidisciplinary group of experts in neurology, primary care, cardiology, pharmacology, women's health, and epidemiology.
Evidence and Consensus Process: An exhaustive search of the relevant published literature was reviewed by each panel member in preparation for an open roundtable meeting. Pertinent issues (eg, cardiovascular pharmacology of triptans, epidemiology of cardiovascular disease, cardiovascular risk assessment, migraine) were presented as a prelude to group discussion and formulation of consensus conclusions and recommendations. Follow-up meetings were held by telephone.
Conclusions: (1) Most of the data on triptans are derived from patients without known coronary artery disease. (2) Chest symptoms occurring during use of triptans are generally nonserious and are not explained by ischemia. (3) The incidence of serious cardiovascular events with triptans in both clinical trials and clinical practice appears to be extremely low. (4) The cardiovascular risk-benefit profile of triptans favors their use in the absence of contraindications.

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These data should be interpreted in view of characteristics of the patient population in migraine clinical trials. Generally, controlled clinical trials with triptans excluded patients with cardiovascular risk factors including known ischemic heart disease, symptoms or signs consistent with ischemic heart disease, cardiac arrhythmias requiring medication, and supine diastolic blood pressure >95 mm Hg and/or systolic blood pressure >160 mm Hg. Thus, the clinical trials data cannot be generalized to migraine sufferers with cardiovascular risk factors.

Triptans are associated with a modestly elevated incidence of chest symptoms (ie, triptan sensations) relative to placebo in well-controlled clinical trials that excluded patients with significant cardiac risk factors or known ischemic heart disease. The chest symptoms in clinical trials were generally transient, mild, and nonserious.

Given the widespread use of triptans, the risk of serious cardiovascular adverse events during postmarketing surveillance appears to be very low. While the risk of a serious cardiovascular event during triptan use appears to be very small, it cannot be dismissed. Serious cardiovascular events, some of which resulted in death, have been reported in association with triptans during postmarketing surveillance. The causal association of triptan use with serious cardiovascular adverse events is difficult to determine based on the postmarketing surveillance data alone.

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The issue of NSAIDS and heart disease has also been temperted with later studies. Celebrex is, in the absence of preexisting heart problems, safe up to 200mg/day, with some increased risk at higher doses. Unfortunately, it doesn't have much punch for pain.

You might ask your doc about using Indocin for the pain. While long term use can cause GI upset, a protective med used with it can control that issue. I was able to use it for 25-years before it caught up with my gut and I still keep a supply on hand for the times when Celebrex isn't adequate. Bottom line: I've found Indocin so helpful that it was worth working around the potential problems.

i cant believe your idiot doctor let you take steriods for seven months straight!!!!!    Any doctor should know thats dangerous, and maybe you should be angry at him for not taking you off the steroids!!  unbelievable!!!! >:(

Even Athletes  that take them know to give the body a break in between "cycles" (god I have learned to hate that word). That Dr is a moron.

I too was told that I have AVN, actually going for an mri this coming thursday as the nuero thinks that there is no way with the limited amounts of pred that I have taken that I could possibly have it.  They think it way just be a flattened femur head that appears on catscan as dying.  They want to use pred for current cycle but need to rule out previously diagnosed avn.  Feel like a guinea pig

well the not so funny thing is, is that u can get avn through 1 dose of steroids, i could have had it for the last year and until it started to hurt i didnt know, its a silent disease, it took about 5 months for my right to hurt after the left one did, its silent and sneaky and u usually find out when its too late, it sucks it hurts and there isnt much to do about it

not to mention the pain meds they give you for arthritis and pain, just move the pain from my hip to my head, id rather my hip hurt than deal with the demon 24 yrs old and shopping for a cane  :-/