My neurologist gave me a prescription for Maxalt Melt to use as an abortive, which I thought would be useful as I can easily carry it around in a pocket.

So far, I've used only two. The first time it seemed to do very little until about 20 minutes into a CH (Kip 7) when it seemed to make the CH just vanish, not like the usual fade over about a minute.

The second time I used it was Wednesday night on a Kip 10, which was the second worst CH I've ever had. It seemed to have no impact at all, even though the beast had fun with me for about 35 minutes.

The next morning I didn't feel too brilliant, although nothing specific. But after lunch I was feeling a bit rough, so I laid down and listened to a podcast. About 10 minutes later I was feeling awful, my heart was pounding like mad, so much so that it was pretty painful and I thought it was going to force it's way out of my chest, which was also feeling tight. I was also short of breath, so in other words, I wasn't feeling too good at all.

My better half called an ambulance and I was taken to hospital as even though the ECG looked ok, my blood pressure was sky high (it's normally fine), my pulse was racing, my hands were icy cold and I was also sweating. That was a fun trip as I've enough medical knowledge to know that they were assuming I was having a heart attack, especially when they were giving me an asprin to chew on and spraying nitroglycerin under my tongue (which helped with the chest pain).

At the hospital they found nothing wrong, with blood tests and ECG looking normal, although it took a few hours for my blood pressure to return to normal.

For now, they are unsure of the cause, with the assumption that it was either musculoskeletal chest pain or a medication side effect.

I'm due to have some tests done in the next few days including a treadmill test whilst wired up to an ECG.

I've zero history of anything like this, so I'm wondering if it's the Maxalt, especially as the listed side effects include chest pain. Obviously I'm highly reluctant to try a Maxalt again as a CH, even though it can be pretty painful, is a lot easier than a visit to the hospital with a very worried partner (she doesn't deserve to go through that again).

What I'm not sure about is the time between when I took the Maxalt, which was just after 9.47pm (my current appointment time with the beast) and the chest pain, which was just after 2pm the next day.

Has anyone else experienced anything similar to this?

If Maxalt was the cause of this, does it mean I should avoid other sumatriptans, like imigran?

I'll be seeing my GP after the weekend, but I'd love to have as much info as I can before the appointment.


One side effect of the experience was that I educated quite a few of the medical staff, both doctors and nurses, about CHs. All most of them knew was that CHs were very painful and that was about it. One nurse was really interested and we had a long chat about CHs as I'd told here that I might get a CH at 9.47 and she was all for giving me morphine for the pain. I think that she was disappointed that my preventative worked (or the beast was asleep) as she wanted to see what it was like and how I reacted to the high flow oxygen (she had everything ready).

So I'm currently hoping for a less eventful weekend!

Maxalt is one of several meds in the same class. They differ in how quickly they become effective and how long is their effective life. They were tailored so because migraine, benefits from being able to match the pattern of migraine to the med.

Imitrex dominates the Cluster crowd because of its rapid onset but has a short life--but that often matches the person's experience. Some folks benefit from a longer lived triptan (the class of these meds) but that judgment can only be made with experience.

Pain meds are not useful for cluster--period! The nurse was curious but not educated.

Re. chest pain and general safety of these meds:


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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Suggest you print this whole article both for your learning and to give to any doc you see. We often have to educate them!


Cluster headache.
From: Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or (Orphanet Journal of Rare Diseases)
[Easy to read; one of the better overview articles I've seen. Suggest printing the full length article--link, line above--if you are serious about keeping a good medical library on the subject.]

Leroux E, Ducros A.

ABSTRACT: Cluster headache (CH) is a primary headache disease characterized by recurrent short-lasting attacks (15 to 180 minutes) of excruciating unilateral periorbital pain accompanied by ipsilateral autonomic signs (lacrimation, nasal congestion, ptosis, miosis, lid edema, redness of the eye). It affects young adults, predominantly males. Prevalence is estimated at 0.5-1.0/1,000. CH has a circannual and circadian periodicity, attacks being clustered (hence the name) in bouts that can occur during specific months of the year. ALCOHOL IS THE ONLY DIETARY TRIGGER OF CH, STRONG ODORS (MAINLY SOLVENTS AND CIGARETTE SMOKE) AND NAPPING MAY ALSO TRIGGER CH ATTACKS. During bouts, attacks may happen at precise hours, especially during the night. During the attacks, patients tend to be restless. CH may be episodic or chronic, depending on the presence of remission periods. CH IS ASSOCIATED WITH TRIGEMINOVASCULAR ACTIVATION AND NEUROENDOCRINE AND VEGETATIVE DISTURBANCES, HOWEVER, THE PRECISE CAUSATIVE MECHANISMS REMAIN UNKNOWN. Involvement of the hypothalamus (a structure regulating endocrine function and sleep-wake rhythms) has been confirmed, explaining, at least in part, the cyclic aspects of CH. The disease is familial in about 10% of cases. Genetic factors play a role in CH susceptibility, and a causative role has been suggested for the hypocretin receptor gene. Diagnosis is clinical. Differential diagnoses include other primary headache diseases such as migraine, paroxysmal hemicrania and SUNCT syndrome. At present, there is no curative treatment. There are efficient treatments to shorten the painful attacks (acute treatments) and to reduce the number of daily attacks (prophylactic treatments). Acute treatment is based on subcutaneous administration of sumatriptan and high-flow oxygen. Verapamil, lithium, methysergide, prednisone, greater occipital nerve blocks and topiramate may be used for prophylaxis. In refractory cases, deep-brain stimulation of the hypothalamus and greater occipital nerve stimulators have been tried in experimental settings.THE DISEASE COURSE OVER A LIFETIME IS UNPREDICTABLE. Some patients have only one period of attacks, while in others the disease evolves from episodic to chronic form.

PMID: 18651939 [PubMed]
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Also print out the PDF file, below.