100mg is the higest oral dose. I would NEVER take two at the same time. One, why put yourself in that kind of a position, doubling the dosage of a pretty strong vasoconstrictor, and 2) why waste it if you might need it later.

I'd give it one more shot with your GP. Print some of the most relevant stuff from the oxygen info link at the left of your screen, give it to her, and ask again. If she still says no, find somebody else.

In the meantime if you're looking to get relief from those 100mg tabs, I would break them in half to get roughly 50mg each time you take it.  This is what I did years ago.  The only way I got relief from these pills was to take it about 1/2 hour to an hour before I knew one would come.  YOu certainly DON'T need 200mg to kill a cluster.  You're playing with fire and you could get rebound headaches from a dosage that high.  If you have onset symptoms (shadows), Imitrex tabs won't work.  Energy drinks, O2 or the Imitrex injection is the best thing at onset.

Hope everything works out with your GP.

Search for that neuro though.

Cheers,
Chad

A pill dose of 200mg is not appropriate, per U.S. standards of practice. But you don't have to tell the doc that you only took 100mg!

But, the pill form is the least effective for Cluster, in our collective experience. The injection form is the best, by far, followed by the nasal spray (used with correct technique.)

Re. oxygen: what follows are medical sources of information which you can print and give to your doc. (It's always best to use medical sources, when you can, in negotiations with a doc!)

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The National Headache Foundation:

Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

The Mayo Clinic:

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Dr. Todd Rozen:
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Dr. Lee Kudrow:

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On 02-15-05, the American Family Physician published the article "Management of Cluster Headache" by Dr. Ellen Beck, Dr William Sieber and Dr. Raul Trejo. In the Acute or Abortive Treatments section, it states that oxygen and sumatriptan are the "treatments of choice for acute cluster headache."

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Headache. 2005 Jan;45(1):98.   


CLUSTER.

[No authors listed]

Rozen TD. High oxygen-flow rates for cluster headache. Neurology. 2004;63:593 The two most effective cluster abortive agents are injectable sumatriptan and inhaled oxygen. Because most cluster headache sufferers are cigarette smokers and at high risk of coronary artery disease, many develop contraindications to triptans. Oxygen, the safest of all cluster therapies, is not effective for every patient. In Kudrow's landmark study, 75% of patients responded to 100% oxygen at 7 L/min, although only 57% of older chronic cluster headache patients had relief. A recent study documented a gender difference in response to oxygen because only 59% of female cluster patients responded to oxygen, whereas 87% of men did. In most textbooks and articles on cluster headache treatment, patients are instructed to use 100% oxygen via a nonrebreather face mask at 7 to 10 L/min. The rationale behind this prescribed oxygen-flow rate is unknown but has become doctrine since the Kudrow study. Prescribing higher flow rates of oxygen up to 12 L/min has recently been suggested, but there is no documentation that this may improve efficacy. Higher oxygen-flow rates (up to 15 L/min) are not known to benefit cluster headache patients refractory to standard oxygen therapy. Three cluster headache patients who demonstrated no response to standard oxygen therapy were exposed to higher flow rates of oxygen (14 to 15 L/min) to assess response. Comments: Once again, Dr. Todd Rozen's observations will change my clinical practice!-Stewart J. Tepper, MD I have questions: Were these empirical observations or do Drs. Kudrow and Rozen know how rate of flow affects oxygen delivery? Is oxygen uptake higher with higher flows? After all, 100% oxygen is 100% oxygen unless under hyperbaric pressure! Perhaps higher flow rates dry the nasopharyx to a greater extent. If patients perceive a higher flow rate, might this be an enhanced placebo effect? It seems like an interesting study to be conducted, and it would be useful to test if using nasal cannulae is just as good. Pulse oximetry and arterialized capillary blood gases could be used to monitor oxygen saturation and CO(2) retention/carboxyhaemoglobin levels in smokers.-David S. Millson, MD.

PMID: 15663630 [PubMed]
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Finally, please reexamine what you mean by "experiment" re. using meds. Those of us with cluster often spend years changing meds and doses in an effort to find meds which are effective for us. For reasons which are not understood, our bodies will not work with one med (which other folk find effective) and/or one which has been effective for us stops working. Then, you have little choice except to try others (or live with the pain).

The greatest danger is  misuse of meds--changing doses  and mixing meds without medical guidance.
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Print the PDF file, below:

Agree with what others have said.  I've been using Imitrex for 20 years (shots, nasal spray, and pills) and have never even taken 100mg per dose much less 200mg.  I didn't even know that they had 100mg pills, I've only ever used 25mg and 50mg pills.  Definitely buy a pill cutter and only take half of 1 pill.

I know that Imitrex pills are the least effective form of this medication (shots being the best and spray being second best), but it still can help.  It all depends on the length of your attacks.  For me my hits last between 1-3 hours, so if I take a pill at the first signs of a hit and have to wait 30 min for it to work it's still worth it to me.  Sure, if your hit lasts 20-60 min it's not going to be a good choice.  You should absolutely bring the O2 info back to your Dr to try to get an O2 script.

Good Luck

Brew wrote on Jan 26^th, 2010 at 5:08pm:
The pills I do have left I use when going out to dinner or something so my fun isn't spoiled by a darn CH.  I will take it before I go out as a couple hour prevent.  I have noticed that is does work longer.