Hello,

I get Clusters every two years for about 5 weeks at a time 2-4 times a day for the past 16 years. I am now 3 weeks in this cycle and I have gotten only 2 a day I have have been using my trex 4mg injections for about 1 week everyday I am going to the Doc today to try and get O2. My question is can you develop an immunity to trex? For me it still works but I am worried that it will stop working if I keep taking it everyday till the end of my cycle which I pray is very soon.
Also I have not looked into other options since my last episode 2 years ago any ideas?

mine are allot like yours , every couple years  for several weeks , I have learned from this site that its a good idea to try and take a prevenative also , then your trex or o2 to abort or stop one thats comming , I tried to do it without this cycle and payed for it , many take verapamil , I am now , and if I have to steroids.

I went to my Dr. and was told to keep taking the trex and that o2 was a bad idea. The Dr. I had 2 years ago was great then we moved so I had to find a new Dr. and he has little knowledge of clusters. Not good!

PGHgirl,

Punch the Beast multiple ways, with more than one weapon. 

Abortive:  O2 first, trex when caught without O2
Transitive:  steroid, e.g. prednisone (caveat emptor)
Preventive: verapamil, lithium

Sounds like you're relying on the Trex alone, and there may be better ways to consider.  O2 works for me (with pred some times), until verapamil kicks in to prevent.  IMHO daily O2-ing beats daily Trex-ing.

Fox

Read thru the link below from the Michigan Headache & Neurological Institute. Current O2 flow rates are a minimum of 15lpm.

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If your Dr won't listen about O2, you should find one who will. Overuse of Imitrex can kill, O2 will not.

Don

Please see Bob Johnson's post about triptans for more accurate info.

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 ]
============

Headache. 2004 May;44(5):414-25.Related Articles, Links
Consensus statement: cardiovascular safety profile of triptans (5-HT agonists) in the acute treatment of migraine.

Dodick D, Lipton RB, Martin V, Papademetriou V, Rosamond W, MaassenVanDenBrink A, Loutfi H, Welch KM, Goadsby PJ, Hahn S, Hutchinson S, Matchar D, Silberstein S, Smith TR, Purdy RA, Saiers J; Triptan Cardiovascular Safety Expert Panel.

Department of Neurology, Mayo Clinic Scottsdale, AZ 85259, USA.

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.

Publication Types:
Consensus Development Conference
Research Support, Non-U.S. Gov't
Review

PMID: 15147249 [PubMed - indexed for MEDLINE]

I had the worst HA of my life 10++ this morning so exhausted! I am working on finding another Dr. to give me o2 and tonight I am trying Melatonin any idea on how much I should take?? 


Also thank you for all the advice soon as I get a new Dr. then I will be able to try new ideas.

Hi Bob

I took the trex with the HA this morning it took about 20 mins
and I did get relief. I was just thinking of taking the Melatonin to help with my sleep pattern. Not sure if it will do that or not?

I have been taking the trex 1 a day for about 10 days and I have 6 more days and I run out of my stockpile then I will have nothing to take. I can not afford more trex and I have no health care coverage I have the trex from when I had Ins. I stocked up.  Also this is why I have such a bad Dr. no health Ins = poor Dr. and poor care.




Praying for PF days!!

Hi PGH Girl,

The reports I've seen here from fans of melatonin have them taking around 9 mg before bed, and sleeping thru the night with no attacks.

Didn't work for me, but IMO it could be worth a try for you. I'll probably even try it again in the future for the heck of it.

Have you become aware of the ClusterBuster approach to fighting CH yet, as outlined in this Newsweek article?

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I am willing to try the jumping jacks if I can muster up the  strength next time I feel a CH coming on.

Still trying to get a Dr. to give me the o2   
Sigh

PGHgirl wrote on Apr 20^th, 2010 at 4:57pm:

    Buy your own o2, no muss no fuss no script needed.

              Potter

Below is a link with a tip on how to split your Imitrex.
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Don

I use exercise alot to deter the constant/daily shadows.  More often than not it works.  Have been known to avoid a hit this way too.  And it keeps my son happy ... nothing like running around the oval kicking the footy