Today I was trapped on a plane with a break thru-my-verapamil attack. 

I held off on using Imitrex, as it never got to the point where I couldn't deal.  Close, but not quite.

However, though the pain never peaked over a 5, the HA ended up lingering (I think "fluttering", not "shadows") for several hours, causing my subsequent business meeting to be uncomfortable.    I regretted not using a shot.

And I tend to do this.  I am scared to go over the 2 per 24 hour rule, and I am scared to "waste" one of the precious abortives.

Does anyone else do this?  Hoard the shots until the pain hits the "can't sit still" point?

When I fly, I always buy a red bull at the waiting area, that's my first round abortive when flying. I am fortunate in that oxygen is so effective for me I never had to hoard my trex, I always had a few around for those rare times when I got caught away from my oxygen, such as flying. But I hear you...when you have to balance pain tolerance with the financial reality of your abortives.... :-/

Joe

I do hoard Imitrex & I use it as my last line of defense, but when I'm out and it's the only thing I have between the BEAST & I, I won't hesitate to use it. There has been TOO MANY past experiences where I knew I waited too long and suffered unnecessarily.  After dealing with the pain so many times when I had medicine right there and just waited too long and was now waiting on it too kick in, I vowed never again (a few times), when the BEAST attacks, I will attack back immediately (when possible) and I WILL NOT SUFFER when I could've stopped it in it's tracks before it got so bad (which also makes an attack last longer for me)

So, YES - I've said to myself, "Wrong Move" many times ... but I plan on NOT doing that again. It's unnecessary torture & suffering ... and I've ha ENOUGH of that !

PFDAN

I4B

My "ALARM CLOCK" went off at 3:05 am this morning and was a real 'Bell ringer' !!

As the others have said, I absolutely know what you mean. Not only am I reluctant to use up one of my resources, I am convinced the next headache following a trex abort is actually stronger than the one treated. Maybe it isn't but it feels that way. Still, I have some success using vials and syringes so I can modulate the dose. I can abort with 2.5ml almost as effectively as with the full .5ml of the autoinjector. Having said that, I still use the autoinjector when out and about rather than a bare needle. blessings. lance

If you are using the auto injector, check out the imitrex tip on the left.  I never use more than a 2 mg shot.

For a long time we have recognized that delaying use of Imitrex, et al, is a mistake. When an attack is well/fully deveoped, it's benefit is meager. So, take at the first sign of a developing attack.
===
IF you do not have a recognized heart problem, the 2 in 24 guide is too conservative.
--
Expert Opin Pharmacother. 2010 Nov;11(16):2727-37.
Sumatriptan therapy for headache and acute myocardial infarction.
Barra S, Lanero S, Madrid A, Materazzi C, Vitagliano G, Ames PR, Gaeta G.

SourceAntonio Cardarelli Hospital, Cardiology Unit, Via Antonio Cardarelli, 9, 80131 Naples, Italy. giovanni.gaeta@tin.it

Abstract
IMPORTANCE OF THE FIELD: Migraine is a common, debilitating, chronic neurovascular disorder. Triptans are considered the drugs of choice to treat migraine attacks; however, their use is limited owing to concerns about cardiovascular safety.

AREAS COVERED IN THIS REVIEW: The aim of this review is to describe: the mechanisms of action of triptans; the case-reports of acute myocardial infarction (AMI) associated with sumatriptan use; and the results of studies evaluating its tolerability and safety.

WHAT THE READER WILL GAIN: Sumatriptan administration can be followed, in close temporal relationship, by AMI in young or adult migraine patients. Some of these cases have developed in subjects taking their first dose. Based on the results of prospective studies,

THE RISK OF SEVERE CARDIOVASCULAR ADVERSE EVENTS AFTER THE USE OF A TRIPTAN IS ESTIMATED AT 1:100,000 TREATED ATTACKS. THESE ADVERSE EVENTS, ALBEIT VERY INFREQUENT, HIGHLIGHT THE IMPORTANCE OF CAREFUL ADHERENCE TO THE SUMATRIPTAN PRESCRIBING INFORMATION.

TAKE HOME MESSAGE: Inherent in its mechanism of action, sumatriptan could produce (coronary) vasospasm sometimes followed by AMI. The drug should not be prescribed to patients with history, symptoms or signs of ischemic vascular disease; an in-depth evaluation should be carried out in subjects at intermediate cardiovascular risk.

PMID:20977405[PubMed
===============
An option, which is especially good because of convenience (pill) and cost per dose. (The only limitation is if you need seveal doses per day.) This became my only abortive when I discovered how rapidly it worked.
--
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.

PMID 11576207 PubMed

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

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.
=====

I've been enjoying a great reduction in hits since (I assume) this D3 is finally doing me some good. I've only had a couple of attacks in the past week versus the 1, 2, and even 3 hits each and every day/night for weeks.

However, my alarm clock, as I4B put it, woke me up at 2:58am this morning, unfortunately. Since the only other attack I had a few days prior never really got bad, I made the mistake of thinking this one would be similar, so I waited to take the shot. Big mistake. As some others experience, the wait made the shot all but ineffective, and the hit got much worse than I had HOPED it would, so I got a reduction of hell at best.

If not for the ridiculous cost of the stuff even with my using the Imitrex tip religiously, I'd take the shot immediately as soon as I knew the attack was setting in. In fact, I did that for a good number of the earlier attacks in this cycle. But, once that bill starts racking up, and I start running out of money, I start trying to play "tough guy." And, it downright sucks.

Hope everyone finds some PF time. As for myself, I'm hoping the D3 puts the beast back wherever it was on these much needed "vacation" days!

Before flying I always pop a Triptan pill. Useless as an abort, priceless as a flying prevent. Have never managed to contain an attack to "manage to sit through" level on a plane.

For me the jury is still out there whether splitting an imitrex dose is the way to go.

Though a 2-3mg shot does abort (eventually), each time I have tried a 1/3 or 1/2 dose the beast was back "within the hour".

Cost aside, taking the full shot has always given me several hours of relief and a much quicker abort time.

I'm curious? when flying does it trigger a CH attack only
when your in a cycle, or when out of a cycle as well.
I've always avoided flying during Spring and Autumn when in a cycle. But travelled to the UK in August and came back in September and no CH's.

Hoppy.

I fly quite frequently.  It seems that flying is not so much the trigger as "flying during my normal CA time of 10:30 AM" is the trigger.

For all of my worrying and preparing for a hit while flying, it's never happened.

Joe

I've flown about 250 times in the last 3 years and I've never had a headache, CH or migraine, whilst flying, so for me it has been the perfect preventive. However I'm always prepared when flying just in case.

neuropath wrote on Nov 17^th, 2013 at 9:47pm:

For me the jury is still out there whether splitting an imitrex dose is the way to go. Though a 2-3mg shot does abort (eventually), each time I have tried a 1/3 or 1/2 dose the beast was back "within the hour". Cost aside, taking the full shot has always given me several hours of relief and a much quicker abort time.

I've had the same result.
Just recently, I was getting low on injectors and split 4 into 8 and did not have good results.
Abort times took about 25 min or non existent if I didn't catch it early enough.
I had one attack that went straight to a KIP 10 after 1/2 dose and it stayed there for 30 minutes.
Being 6'2" 195 lbs, a whole dose works much better for me.

Using a whole dose, I can kill a KIP 6 that wakes me up at 0330 in less than 5 minutes and be back to sleep before 0345.
A half dose results in an attack that continues in intensity to a KIP 8 and only takes the edge off.
At this point in time, if / when I get low, I will save the full dose injectable for my night attacks and hope that I catch the daytime ones early enough with an energy drink.