If I understand, you may divide a 6mg dose into as
much as 4 doses  or 1.5mg per injection.

If so, likely this too small a dose to give sufficient action.

OR, if you are monitoring the attack before you decide the dose to use this leads to hitting a developing attack with some delay. Even with a full 6mg dose, a well developed attack (and they do develop rapidly, no?) may fail. The general "rule" is hit with an abortive (any of the commonly used ones) before it's well developed.

General idea: better to "waste" a dose responding at the first sign of an attack to a false alarm than to delay and experience failure to get relief by too much delay.

Hi GinaB, Bob,

It's hard to get the jump on an attack when asleep, for sure. I know Goadsby and others advise that speed is of the essence when getting a triptan into you and I agree.

But they go one step further and say that once a CH attack has started, a triptan will not work. For me this is complete crap and GSK's literature confirms this. At any point during CH attack, first preliminary signs, right through to full blown 1+ hour(s) in, Sumatriptan injection always works for me. It is a 100% effective magic bullet, if I use it.

From the manufacturer (GSK) Imigran injection datasheet:

Quote:


Respectfully Bob, with regard to administration of Sumatriptan injection, I disagree with the notion of "delay and experience failure to get relief". So do the manufacturers and my specialist.

I know some CHers report this experience, but I think the idea that one can "miss" an opportunity to use Sumatriptan injection is false, especially for people like me who get the full 180+ minute attacks. CH seems once started, to be considered a freight train that cannot be stopped, I know for few triptan users, this is the case. Perhaps they should select a different triptan or ergot-alkaloid. In my experience, for the most part Sumatriptan injection will assist dramatically, even after awakening with CH attack in full flight.

Many of the patients I've assisted here in Oz echo that sentiment, even validating the extensive use of selected oral Triptans in their individual cases. Oral triptans are yet another example of a technique deemed invalid in CH by Goadsby and his cohorts.

Similarly, with 35 years practice I can lay down and writhe in a dark room, no longer resorting to pounding my head against a wall, but Goadsby and co would have us believe that "pacing the room", "bashing head against the wall" are in fact, necessary differential diagnostic criteria for CH and that in their absence, our collective CH diagnoses should be called into question.
This is wrong.

It would be fair to point out that Goadsby and co have neither had a CH attack, nor used a Triptan.

(Before I again get the links to Headache Specialists and "Cluster-like" headache - I should point out that my CH diagnosis is solid, textbook CH and 35 years consistent, "confirmed" by 8 years as a patient of a leading headache researcher)

Before the Vitamin D3 regimen, I for many years, awoke with force 10 CH well in progress and hit it with 6mg Imigran injection. There is nothing else I could have done. I had trialled 70 drugs that failed and I'm not going to take Imigran tablets "before bed" as a preventive, that's bad practice and bad medical advice for long term use.

I'm very lucky here in Oz, I get 6-12 injections for $6 through a public teaching hospital, so I've never had to divide them. I feel guilty for having such privileged access here, I know how much everyone else here experiences the difficulties of obtaining injections. From the relative luxury of this position, it would seem to me that dividing injections is almost exclusively a product of the immense cost nearly everyone else faces around the world for these injections. I do agree, 4mg would get the job done.

My specialist says doses are selected at 6mg for good reason and not to divide them. 6mg IS a divided dose. Initial trials of the drug used 12mg in subjects, but increased side-effect profiles, with no more effective an outcome in it's intended purpose. As principal creator of Zolmitriptan, with particular expertise in both CH and specialist experience with this drug group, I defer to his expertise.

The time to Sumatriptan full plasma concentration and elimination half-life are very short, so divided dose or not, it is not going to "last" very long at all. It aborts an attack, I don't know why so many people expect triptans to then "hold off" an attack, they are not designed to do this, they never were - check the plasma graphs. Headaches can recur very soon after a 6mg s/c injection.

Quote:


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I realise this is a cost-prohibitive exercise for most, but it does point out how quickly Sumatriptan injection is eliminated from your body and blood stream, explaining the recurrence, return or commencement of new CH attacks.
From the manufacturer (GSK) Sumatriptan injection datasheet:

Quote:


Link to the data sheet, every Sumatriptan user should have one of these:

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Sumatriptan is eliminated from the body very quickly.
Users should be aware of this.

Some may think I am here to advocate Sumatriptan use.
I hate the vile drug and would not wish it on anyone.
Sometimes I endure CH attack, rather than use it and risk rebound and recurrence.

For the record, just this year, this is how much Imigran I have not had to use (and then some) since the D3 regimen became effective for me.
Seeking out any and all possible preventives, including the D3 regimen is worth consideration, when staring down the barrel of this, or endless CH attacks.

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Apologies for my disposition.
I've been re-visited and am waiting for D3 loading doses to kick in. I can't, nor would I offer up excuses here, you all know how it is.

Cheers, Ben.

Hello Ben,

Maybe it's just me...probably so...but I find the" tone" of some of your posts speaks so loudly I cannot hear what you are saying...and that's a shame...

Best

Jon

I agree with most of what the others have said about Imitrex. It's meant to abort an attack and is out of your system quick. It will not prevent attacks hours later. It can cause rebounds. If you feel you must use it,  then use it at the first sign of an attack.

My advice: Try to find a way to prevent the need to use Imitrex in the first place. 

I4B

PS. Splitting doses is not the greatest of ideas, although many of us have done it and some still do. Instead, try getting the Imitrex 6mg vials so you can draw up smaller amounts and eliminate the re-using of a syringe more than once. And ... I would not recommend injecting the stat doses into empty, used vials.

The Imitrex has been a huge to me and my ch's. I have just started Botox and found it to offer a large amount of relief. I have had 3 treatments over the last 9 mos and it has allowed me to go long periods without headaches and even stockpile some Imitrex.

Thank you all for the replies.  I've been on Verapamil for about 5 years, with good results. I even went 2 years ha free! This particular cycle is in the 3rd month, much longer than any in my 12 years of dealing with CH. I'm brand new to the immitrex and I guess I was just expecting better results. Almost every time I use the immitrex whether its 1.5mg or 6mg the pain goes away quickly but always returns in a few hours.  Until recently I used zomig tablets, with relief taking 45 minutes typically. But then I was good to go until the next night. I just wish the immitrex would work that way too.  I think I'd rather suffer longer and know I'm safe for the rest of the day,  then to have multiple ha in a day. Thanks again.