Hi
I have been prescribed Sumatriptan tablets and have been taking 2 a day for just under 5 weeks. This works in aborting the CH's but I now have a shadow that lasts nearly all the time and are getting stronger and generally feel hungover, could this be a side effect from the meds?

Oxy
I'd say its a possibility, I have posted this before so to those of you who have already read this ..sorry!

My 1st appointment with the neurologist ended up with me being taken off all my meds.
Let me go back a step.. the referral to the neuro happened because of the amount of repeat scripts I was getting for sumatriptan.
I was taking anything and everything I could to try to stop the pain (paracetamol, nurofen, diclofenac, all the codeine's and sumatriptan nasal and tablets)!
When I spoke to the neuro she pointed out that headaches can be caused by over medicating and sumatriptan is known to cause them.
The cure was to stop all meds and start keeping a diary, if the pain became too bad I could take an aspirin (as much use as a chocolate fire guard!) but I did the 6 months and at least I now have a base line of my cycles and level of pain I get without meds.
Fingers crossed for PF days and nights
Sue  :)

I doubt it. Shadows are just part of the CH experience.

Sumatriptan has been blamed for rebounds though.

These are hard questions to sort out without stopping he suspect med and see what happens.

Overall, using the injection form will probably give you greater/faster relief without loading up on the pill.
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Headache. 2004 Jul;44(7):713-8.   

 
Subcutaneous sumatriptan induces changes in frequency pattern in cluster headache patients.

Rossi P, Lorenzo GD, Formisano R, Buzzi MG.

Objectives.-To document the relationship between the use of subcutaneous (SQ) sumatriptan (sum) and a change in frequency pattern of cluster headache (CH) in six patients. To discuss the clinical and pathophysiological implications of this observation in the context of available literature. Background.-Treatment with SQ sum may cause an increase in attack frequency of CH but data from literature are scant and controversial. Methods.-Six CH sum-naive patients (three episodic and three chronic according to the International Headache Society (IHS) criteria) are described. Results.-All six patients had very fast relief from pain and accompanying symptoms from the drug but they developed an increase in attack frequency soon after using SQ sum. IN ALL PATIENTS, THE CH RETURNED TO ITS USUAL FREQUENCY WITHIN A FEW DAYS AFTER SQ SUM WAS WITHDRAWN OR REPLACED WITH OTHER DRUGS. Five patients were not taking any prophylactic treatment and SQ sum was the only drug prescribed to treat their headache.

CONCLUSIONS.-PHYSICIANS SHOULD RECOGNIZE THE POSSIBILITY THAT TREATMENT OF CH WITH SQ SUM MAY BE ASSOCIATED WITH AN INCREASED FREQUENCY OF HEADACHE ATTACKS.

PMID: 15209695 [PubMed]

{Note from BJ: Review of PubMed in 1/11 found no citations with this type of data in the last 10-years. The absence of newer reports suggests that experience of recent date is not stimulating much attention on this topic. In view of this reports comments about quick return to the former headache pattern, it appears such changes in frequency is not a significant issue.}

hey your not alone, for the last few weeks ive been taking imitrex almost twice daily and i also almost always have shadows the entire day but i doubt its a side effect of the imitrex.  Although i do feel like a zombie everyday, probably from all the preventitaves im taking...  :-/

Shadows are not solely associated with sumatriptan.

The only way to determine the source is to stop any suspect med for a few days and see what happens. There are no clinical/chemical tests to determine the source.

Are you using a standard preventive med?, at sufficient dosing?

Sort of issue were having an experienced doc is essential.

I always get periods of the constant shadows.... when I used sumatriptan and when I do not. For me, I dont think its the culprit.  I'm more inclined to speculate that the preventative (verapamil) is a more likely cause, and/or its just part of having CH.  Its still preferable to my un-diagnosed days when I used nothing at all - I seem to recall getting shadows then too, on top of a lot of painful attacks and the "aftershock" lingering pain after a really brutal polka dance with the Beast.   

Do you have access to the injection type, or at least the nasal?  As Bob alludes to, they have a much faster response, in fact for most folks the pills take 30 minutes to work, which often is just in time for the end of the attack i.e. not very useful.  I can only get the pills where I live (Vietnam) and so I dont really bother....O2 works better anyway. 

Personally when the shadows get too distressing or annoying I find that doing something different (but not too relaxing..) like going outside, helps clear the fog a wee bit.   

Wishing you pain-free days...

We tend to use "rebound" a bit too robustly here AND, in the closed context of our chats, it can take on a meaning which is not always consistent with the medical usage/meaning of the word.
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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.)
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Sumatriptan has a hard initial punch and relatively short effective life--a combination which works well for most Cluster attacks. However, some people, whose Clusters have a longer life, find that the med is wearing down even as the pain continues. One can understand how this sequence comes into one's thinking: Attack, Imitrex injection, pain continues, it's a rebound cluster which has developed from the Imitrex. In fact, this is a recurrence of the attack, not a rebound.

This is one of the reasons that several other triptans were developed having less initial punch but longer effective life. While aimed at the migraine crowd, at first, a number of cluster users have found this characteristic of value to them.
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P.S. After this issue is raised I often look at PubMed for the latest literature on the subject. It' striking that from the late 1990s  to date there has been so little reporting of rebound with sumitriptan. Suggests to me that: 1. either this is not a medical issue, and/or, 2. there may be continuing confusion of the descriptive terms (as I outlined from Warner.)

I used to think rebound headaches were actually another attack, until I quit using Sumatriptan as an abortive. It has been my experience that triptans cause more headaches. I think therefore I am. ;)

You have written--in effect--ALL triptans cause rebound. It may be perfectly true that Imitrex caused you rebound but that is an important qualification that limits the experience to what you have personally had. Can't fuss with that.

There is no evidence that ALL tripans cause rebound.

A message I posted sometime ago:


Sumatriptan & Rebound headaches (In Medications, Treatment and Therapies)
Dec 12th, 2009 at 9:35am       There has been an increasing declaration in some of the messages here that, "Imitrex/sumatriptan causes rebound headaches."

Sometime ago the caution was, "it can cause rebound", a statement which was consistent with what is found in the medical literature.

"Imitrex causes..." is both a misstatement and--my concern in writing--it scares people away from using the most effective abortive we have. A tendency to puff up statements/claims, etc. in very common in communication but I'm urging care/caution when we are offering assistance to vulnerable folks who are seeking our help.

I've just spent a hour searching medical literature sites and it's striking just how very limited are any studies/reports/warnings about side effects with sumatriptan. I found this one definitive statement from 2003. Please note two facts: the vulnerable age and the low rate of rebound:

"Medication-Overuse Seen as Epidemic, First Management Guidelines Issued: Presented at IHC "
By Larry Schuster ROME, ITALY -- September 25, 2003 -- 

The prevalence was highest in respondents who were their 50s, with 5% of women fulfilling the criteria. Thirty five percent overused simple analgesics, 22% ergotics, 12.5% opioids, 2.7% triptans, and 27% overused combinations of drug classes."

 

I have always have shadows with my cycles and have never used Imitrex.  Also, I have used different meds for different cycles through the years and it never changed the shadows.  However, my sister has used Imitrex since it first came out and it actually reduces her shadows and length of cycles.  So, go figure.  :)

Oops, forgot to mention that, over time (20+ years), my shadows have gradually got a little worse, but so have my headaches.

Bob has made some important distinctions for us. Rebound vs. recurrence. When I think of rebound effects I think of how nasal sprays effectiveness shortens in duration with increased usage. Same dose, shorter time between doses to deal with the same issue: a stuffy nose. Recurrent CHs are new attacks which may or may not in some way have been triggered by the the previous attack, but which I suspect is actually just a mark of the cycle we are in at the time. Rebounds are treated with less use of the affecting medication. Recurrents are treated with the same vigor we applied to previous attacks. I have no literature for this but my guess is untreated CHs not only add to our pain, but perhaps influence the cycle we are in for the worse. So if we do not treat recurrent headaches we may be in fact encouraging the next attack. Any thoughts Bob? Blessings. lance

Standard treatment when rebound is suspected is to cold turkey the drug and see what happens. If the headache pattern changes in a few days, assumption is this was the culprit.

The mfg recommendations on Imitrex use (total weekly, etc.) is based on a CYA judgment whereas the med literature is not showing problems using much more frequently (except the ususal heart problem warnng).

In the last few weeks I've heard a couple of reports about the brain becoming rewired when pain is not effectively treated. Still not "fact" but consistent with some disorders, e.g., PTSD/Borderline Disorder, where ineffective/no treatments appears to induce a fixation of the problem. Could be a brain rewiring thing.....perhaps in time we well know.

JONI: Your comments make the point: we can't assume that two events, "I'm using Imitrex + I have shadows" are causally linked. But when we are casually talking/writing it so easy to slip into the mode of thinking.

Bad habit in medicine & science, where we must be able to demonstrate that there is some link between the two events.

Shadows are not a new topic here. For a long time before triptans decended upon us, they have been a topic of concern/discussion. So, whatever Shadows are, or what causes them, is still not clear.

I have has shadows since my last cluster cycle that started in dec 09 and ended around april 2010. I was not taking any meds after 2 weeks or so after my last attack in april. I have had shadows ever since. So just my 2 cent's as to how different the beast morph's for all of us!

Ok, I'm confused ... is it the injectable or the oral that may be causing a "rebound" effect? :-?

Beli has been taking (at the docs recommendation) one 100mg tablet when the pain level reaches three or four on a scale of one to ten. He is usually good for twelve hours of no pain.

All forms of sumatriptan will cause rebound headaches.

Got it, thanks for the clarification. :)

I suspect most Triptans give me rebounds, but I am not sure at all.  What really grabbed my attention though, was this:


oxyrunner wrote on Feb 28^th, 2011 at 3:30am:

Hi I have been prescribed Sumatriptan tablets and have been taking 2 a day for just under 5 weeks.

Anybody else think that's WAY too much trex to be taking in a month?  My Doc says for safety he won't prescribe me more than 1000 mgs in a month (10 100 mg pills)

Ricardo wrote on Aug 3^rd, 2011 at 4:16pm:

Anybody else think that's WAY too much trex to be taking in a month?  My Doc says for safety he won't prescribe me more than 1000 mgs in a month (10 100 mg pills)

Depends. The safety guidelines are put in place mostly by the drug companies themselves so they're covered legally. If your ticker is strong and you don't have any other issues, it's pretty much safe to take them every day as long as you don't exceed two doses in a 24-hr period. This should only be done with your doctor's blessing, however. He or she needs to be convinced that your circulatory system can take it.

Oxy, have you tried the injection instead of the pills?  Sometimes when I take too many pills, I get a lot of shadows too.  The shot usually knocks them away for a while.

Good luck,
Mia