Posted by gary g (208.133.217.149) on October 13, 1999 at 11:32:54:
In Reply to: I disagree, Rebound ~ definitely posted by W. on October 11, 1999 at 22:28:16:
there may well be "rebound" attacks in certain cases - in the case of CH that's more a question of word use than a particular event, I think
but in the post we're discussing, there were a couple hours without attack symptoms, then more attack symptoms -
that is COMPLETELY consistent with many, many cases of CH regardless of medicine type or frequency;
but I'm trying to understand what you mean-
you said:
""For years prior to trying Imitrex, I hardly ever had them during the day (almost never). When I started Imitrex I was getting one every 2-3 hours all day long. I stopped Imitrex for this reason, and now get clusters at normal (is there such a thing!) times ~ during the night""
really sounds more like a pattern change over time, which is completely consistent with "normal" CH natural history
rebound is when pain comes back the same or worse after taking (usually too much) of a medicine for too long and then stopping, sort of the body overcompensating for the switch in chemistry -
in a "stretch" you might include a situation where there is a physical process going on that causes the pain, medicine helps suppress that pain, and the medication is stopped before the causal activity has subsided, so of course the pain is felt again - but in those cases, it's still the same attack event, it just wasn't over yet when the relief agent wore off
it's important to realize that in CH the attacks are discrete physiological events that occur in a series, within an underlying ailment that lasts a long time -the cluster
if you DO have CH,(and that's not a challenge to you, it's a conditional on my statement) then night attacks are VERY VERY normal, can't accurately blame 'em on the meds, because there are WAY too many cases where they happen regardless of meds
if you DO have CH, ( ditto /conditional) then the fact that the pattern shifts over time , alone means nothing - that to is the usual rather than the exception
Don't forget CH attacks can last anywhere from 15 minutes to 2 hrs or more, and vary within patients and within clusters, and some abortives only work as they're being used (a lot of the physical techniques, oxygen, etc) take 'em away too soon and HELLO the damn thing's still there
~~~~~~~~~~~~~
PREMISE:
until somebody learns to distinguish the various LEVELS of symptoms that occur in CH (there's a lot more to it than just a series of weird pain attacks) it is REALLY tough to make reasonable assesments of the pattern
so, if someone says the attack goes away, and comes back later in 2 hours, you can only take them at their word and hope they clearly explained what they meant
and in that case,
that would mean all the "precursor" symtpoms also cleared for 2 hours, and a recurrence would thus be just another attack
Why do we care about being fussy about whether there are "rebound" attacks, in general, and why should someone care about their case in particular ?
Easy, it makes a big big difference in figuring out what to do, and what not to do re: the attacks