Check your PM's. 

O.K. you're new,  so look up to the left of the top of the page where it says...Good afternoon "his wife"   you have 1 PM

Linda

Just confirm HOW he is using the oxygen as that's proven critical in it's level of success.

Pure oxygen, at a high flow rate of at LEAST 15 LPM, using a Non Re Breather Mask, started at the first sign of an attack. Some for whom oxygen totally failed them at 15 LPM, found success at 25 LPM.

A relatively new theory on the board revolves around maintaining your arterial PH at a level which makes you less succeptible to attacks. It goes as follows:

Magnesium, Zinc, Calcium Citrate and Vitamin D, washed down with fresh squeezed lemonade, up to 4X daily. I did it 2-3X a day this last cycle and it had a substantial benefit in number and intensity of my hits. It's cheap, no real side effects to sweat, may be worth a shot.

If he hasn't looked at      clusterbusters.com       it's proven succesful for some when nothing else worked.

Thanks for being the supporter you are, you guys keep us sane and we love you!

Joe

Yea, insurance sucks.  I had to go around mine and pay for stuff myself.  I know not everyone can do it but I only use imitrex as a last resort.  Kinda my backup.  I agree with Joe on the O2.  Many more aborts for the money if used as instructed.  Works for me most of the time. 

You may want to check into getting a script for the 6MG vials that way you get a real syringe if your not afriad to use it.  I only use 1/3rd of that when I need one.  Works, a little slower than a full shot but never fails to knock one out.

boski wrote on Aug 20^th, 2010 at 11:12pm:

PERFECT analogy/description!!!   

The easiest way of dealing with this is probably to beg for free samples from the neurologist.  I don't even like trex but I can't seem to visit mine without getting a baggie full of it.

The magic word for dealing with insurance is a "letter of medical necessity" from your physician.  That will usually do the trick, as long as it's an insurance policy and not a self-insured plan.

You may want to look into the side effects/safety issues created with constant use of triptans.  High usage is a bit controversial, which you'll discover if your insurance company does approve you.  At that point the pharmacy might refuse to dispense as ordered.  I ran into that a few years ago with a trial of Amerge as a preventative and a few people posted they had to threaten pharmacists with turning them in for practicing medicine without a license.  I was such a wreck at that point I insisted to the pharmacist that potential heart damage was not a big of a threat as the suicide I was likely to commit if I didn't get the pain under control.  It was a tad over dramatic, but it worked. No more fights with the pharmacy.

Well, I think it's only a theoretical problem.  I've never heard of anyone actually having heart damage unless they combined trex with other drugs they shouldn't have.

In fact, I seem to remember reading a study on the robbins clinic site that said for a small number of people (something like 50?) who didn't have other severe side effects or rebound headaches, daily triptan use caused no heart issues.  VERY small study but perhaps means it's fine.

Dennis' advice is the first step: get the doc to intervene with the insurance company--this is no uncommon and he has the clout to get some changes.

Unless your husand has a preexisting heart problem, there is no concern about frequency of using Imitrex. (If you want medical reports around this question, write me a PM.)
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Are you using a headache specialist or a general neurologist? The latter too often lack training/experience in complex headache disorders. If you want to consider your options:

LOCATING HEADACHE SPECIALIST

1. Search the OUCH site (button on left) for a list of recommended M.D.s.

2. Yellow Pages phone book: look for "Headache Clinics" in the M.D. section and look under "neurologist" where some docs will list speciality areas of practice.

3.  Call your hospital/medical center. They often have an office to assist in finding a physician. You may have to ask for the social worker/patient advocate.

4. Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or ; On-line screen to find a physician.

5. Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or Look for "Physician Finder" search box. They will send a list of M.D.s for your state.I suggest using this source for several reasons: first, we have read several messages from people who, even seeing neurologists, are unhappy with the quality of care and ATTITUDES they have encountered; second, the clinical director of the Jefferson (Philadelphia) Headache Clinic said, in late 1999, that upwards of 40%+ of U.S. doctors have poor training in treating headache and/or hold attitudes about headache ("hysterical female disorder") which block them from sympathetic and effective work with the patient; third, it's necessary to find a doctor who has experience, skill, and a set of attitudes which give hope of success. This is the best method I know of to find such a physician.

6. Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or NEW certification program for "Headache Medicine" by the United Council for Neurologic Subspecialties, an independent, non-profit, professional medical organization.
        Since this is a new program, the initial listing is limited and so it should be checked each time you have an interest in locating a headache doctor.
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With the proper medical supervision, the Verap dose can do upwards of 700-900mg.
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Headache. 2004 Nov;44(10):1013-8.   

Individualizing treatment with verapamil for cluster headache patients.

Blau JN, Engel HO.


    Background.-Verapamil is currently the best available prophylactic drug for patients experiencing cluster headaches (CHs). Published papers usually state 240 to 480 mg taken in three divided doses give good results, ranging from 50% to 80%; others mention higher doses-720, even 1200 mg per day. In clinical practice we found we needed to adapt dosage to individual's time of attacks, in particular giving higher doses before going to bed to suppress severe nocturnal episodes. A few only required 120 mg daily. We therefore evolved a scheme for steady and progressive drug increase until satisfactory control had been achieved. Objective.-To find the minimum dose of verapamil required to prevent episodic and chronic cluster headaches by supervising each individual and adjusting the dosage accordingly. Methods.-Consecutive patients with episodic or chronic CH (satisfying International Headache Society (IHS) criteria) were started on verapamil 40 mg in the morning, 80 mg early afternoon, and 80 mg before going to bed. Patients kept a diary of all attacks, recording times of onset, duration, and severity. They were advised, verbally and in writing, to add 40 mg verapamil on alternate days, depending on their attack timing: with nocturnal episodes the first increase was the evening dose and next the afternoon one; when attacks occurred on or soon after waking, we advised setting an alarm clock 2 hours before the usual waking time and then taking the medication. Patients were followed-up at weekly intervals until attacks were controlled. They were also reviewed when a cluster period had ended, and advised to continue on the same dose for a further 2 weeks before starting systematic reduction. Chronic cluster patients were reviewed as often as necessary. Results.-Seventy consecutive patients, 52 with episodic CH during cluster periods and 18 with chronic CH, were all treated with verapamil as above. Complete relief from headaches was obtained in 49 (94%) of 52 with episodic, and 10 (55%) of 18 with chronic CH; the majority needed 200 to 480 mg, but 9 in the episodic, and 3 in the chronic group, needed 520 to 960 mg for control. Ten, 2 in the episodic and 8 in the chronic group, with incomplete relief, required additional therapy-lithium, sumatriptan, or sodium valproate. One patient withdrew because verapamil made her too tired, another developed Stevens-Johnson syndrome, and the drug was withdrawn. Conclusions.-Providing the dosage for each individual is adequate, preventing CH with verapamil is highly effective, taken three (occasionally with higher doses, four) times a day. In the majority (94%) with episodic CH steady dose increase under supervision, totally suppressed attacks. However in the chronic variety only 55% were completely relieved, 69% men, but only 20% women. In both groups, for those with partial attack suppression, additional prophylactic drugs or acute treatment was necessary. (Headache 2004;44:1013-1018).

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SLOW-RELEASE VERAPAMIL

Dr. Sheftell applauded the protocol for verapamil used by Dr. Goadsby and colleagues, which entailed use of short-acting verapamil in increments of 80 mg. “This method was suggested by Lee Kudrow, MD, 20 years ago as an alternative to slow-release verapamil,” Dr. Sheftell noted.

“I would agree with using short-acting verapamil, rather than the sustained-release formulation, in cluster headache,” he said. “I prefer the short-acting formulation with regard to ability to titrate more accurately and safely. My clinical experience anecdotally demonstrates improved responses when patients are switched from sustained-release verapamil to short-acting verapamil.”

Dr. Goadsby agreed that his clinical experience was similar. “There are no well-controlled, placebo-controlled, dose-ranging studies to direct treatment. This is one of those areas where clinicians who treat cluster headache have to combine what modicum of evidence is available with their own clinical experience,” Dr. Sheftell commented.
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Stock pile YES!!!!  We should have mentioned that tooo!

I'm on 600mg Verap
           150mg Topomax
           Imitrex
Sipping 5 HR Energy seems to be helping kill the last few hits

I went to my MD once with a list of all the abortives and quantities covered by my insurance.  Told him I wanted a script for 6 Imitrex jabs, 6 trex tabs (get the 100's so you can break them in half and have 12 50"s), 6 Amerge, 6 Maxalt, 6 Zomig, etc.