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NikkiG

Sumatriptan Help

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Hi, I’m currently going through a bad period of cluster, 1-2 every day for 28 days so far. Have been taking sumatriptan (imigran) tablet 50mg nearly every day as it is the only thing that seems to bust it until the next one. Does anyone know if taking imigran every day can cause rebound affect or addiction to it? Asked my Dr but he didn’t seem to know! Thanks in advance, Nikki 

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I’m surprised the pills do anything. I took some my mother had a few times before I was able to get in to a neuro when my CH first started. The injections work much better. I think you’re in the UK based on drug names. Here in the states there is a half strength sumatriptan injection called zembrace. It is much more effective. Stops the cluster in 10-20min. Others in the UK have split the 6mg auto injectors open and get 4 doses out of a single shit. There are YouTube videos on it. 

 

To to answer your main question. Triptans can cause s cluster cycle to get worse and can prolong a cycle. I used to go through them like water but no longer do. I use oxygen as my main abortive. It’s the standard of care and your best option to abort. I am chronic so I never get a break and didn’t care I just wanted relief before I got my oxygen. 

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Nikki, [Edit -- Posted this at the same time as Freud -- sorry for the overlap]

Some people think that sumatriptan use will cause rebounds.  I think the only use that's been proven to cause rebounds is overuse, and 1 or 2 50mg tablets a day would not, in my opinion, constitute overuse.  Some people would still say that you are at some risk of rebounds, and possibly extending your cycle. Opinions differ about that. (Sorry I can't be more definitive.)

Most people don't get real relief from tablets -- either the oral type or injections are a lot more effective.

Sumatriptan is not addictive.

Do you have oxygen?  Are you doing the vitamin D3 regimen (http://www.vitamindwiki.com/tiki-download_wiki_attachment.php?attId=7708)?  

Edited by CHfather

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Many thanks to you both! I tried oxygen on my last cluster (about 6 years ago), but I didn't notice a difference. Think I'll go back to Dr and ask to try it again though, and will look into sumatriptan injections. Trying to get through them without meds because I don't want rebounds, but it's excruciating and sometimes I just need the drugs! Have started D3 regimen today. Thanks again for your help, much appreciated, from Australia :) 

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Nikki,

Injectable sumatriptan is a lot better than pills, which take way too long to work.  A lot of people say that sumatriptan can cause rebound headaches.   My neurologist told me to be careful how much of it I took, and offered me steroids for periods when I was using too much sumatriptan.  Steroids like prednisone can be effective and give you a small break from the pain, but they have a lot of side effects that can add up over time.  

Your best bet, however, is oxygen.  First identified in the 1960's as an effective abortive, oxygen is still under prescribed and under utilized for treating clusters.  Over the years, the evidence suggests that higher flow rates are better.  There is a ton of oxygen information on this site, but the quick version for you preparing to talk to your doctors is :

at least 15-25 LPM, high-flow, 100% oxygen from a tank (not a concentrator) through a non-rebreathing mask.

The conventional wisdom I have picked up from this board is that oxygen is so effective that you owe it to yourself to try it again.  It doesn't work as well at lower flow rates, and can cause rebound headaches if not enough oxygen is consumed.  It is essential to have high enough flow rates (15-25 LPM or more if that doesn't work) to abort an attack, and also to stay on oxygen (sometimes at a lower flow rate) for 5-10 minutes after the pain subsides.  Just as important is the type of mask.  You NEED a non-rebreather mask (the one with a reservoir bag on it.  A nasal canula will not cut it.  Don't let them talk you into a canula. 

Because the flow rates required to abort cluster headaches are so high, an oxygen concentrator will not be effective.  They make oxygen out of the air in whatever room they are in, but do not deliver pure oxygen at a high enough flow rate.  You are going to need oxygen in a tank.

I hope this information helps you.  I had to fight with my doctors and my oxygen supplier to get things set up properly, so hopefully you can head all of that trouble off before it happens.  I still sometimes need flow rates higher than my medical regulators allow.  During especially bad periods, I replace the medical flow regulator with a pressure regulator for welding.  This allows me to dial in any flow rate I want. During these periods, I need about 36LPM, and only my pressure regulator can deliver that flow rate.

 

Good luck to you.

 

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Hello Nikki,

I am not sure if triptans can use rebounds but they definitely can cause Medication Overuse Headache (MOH). This is a different headache and IHC has a proper classification for it:

-------------------

8.2.2 Triptan-overuse headache

Description:

Headache occurring on 15 or more days/month in a patient with a pre-existing primary headache and developing as a consequence of regular use of one or more triptans on 10 or more days/month for more than 3 months. It usually, but not invariably, resolves after the overuse is stopped.

Diagnostic criteria:
  1. Headache fulfilling criteria for 8.2 Medication-overuse headache
  2. Regular intake of one or more triptans1, in any formulation, on ≥10 days/month for >3 months.

-----------------------

Now its a bit a choice here between the pest and cholera. Or you take your cluster attacks as they come without MOH risk or the clusters are so painful that MOH is a small price to pay for getting rid of them.

Sumatriptan injections are suggested here. This is indeed more effective against CH attacks and its presented as the standard treatment but also keep in mind that the injections put more pressure on the heart than the pills. When I have a CH flare-up, the attacks follow each other up in rapid succession with continuous background pain in between. So for me the pills are the safer option than injections. I do not use injections but a nasal spray in the worst case (Zolmitriptan for both the pills and nasal). I can also tell you that, if you decide to use the pills, there are much better triptans available than Sumatriptan. You have fast acting ones such as Eletriptan and Rizatriptan or slow acting ones like Frovatriptan or Naratriptan. 

Having said that, keep trying with the oxygen. There are several masks, breathing techiques possible you can try as Chris pointed out but if you can get it working, its a huge benefit !

For me oxygen works like magic. Rebreather, non-rebreather, high-flow, lower-flow, it all does not matter. Whenever I breath in that stuff, the pain goes away within 10 minutes in most of the cases. Even if I stop oxygen after 15 minutes with still 20 % of the pain remaining, that pain also goes away during the next minutes. With oxygen, I have managed to cut down my triptan usage with around 70 %. So it's worth further trying it but patience and creativity is key here.

All the best !

siegfried

 

 

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Hi again all, I'm about to start Vitamin D3 regimen but just wondering if you know if it's best to take all at one time, or can be taken different times throughout the day?

Many thanks

Nikki

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Hey Nikki,

As I'm the CHer who developed the anti-inflammatory regimen and provided outreach on its benefits in preventing CH for the last 8 years to hundreds of CHers, it's best to take this regimen with the largest meal of the day.  This helps avoid GI tract disturbances and aids in absorption.

Many CHers have found starting this regimen with the 12-Day accelerated vitamin D3 loading schedule taking 50,000 IU/day for 12 days.  This is the fastest way to elevate your serum 25(OH)D up into the therapeutic range around 80 ng/mL where most CHers respond with a significant reduction in the frequency of their CH or a complete cessation of CH.  After completing the 12-Day loading schedule, drop back to an initial vitamin D3 maintenance dose of 10,000 IU/day.  30 days after starting this regimen it's best to see your PCP/GP for lab tests of your serum 25(OH)D, calcium and PTH.

Take care and please keep us posted.

V/R, Batch

 

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I don't like sumatriptan pills, gives me acid reflux. All the pills take awhile to work. Best for me though are rizitriptan/maxalt. Also use sumatriptan vials.

I don't think I have any rebound effect and using the above a long time now.

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If I take triptans for more than 3 days I will get rebound headaches. I have to go cold turkey off the triptans or the headaches will come everyday. I am retired so I only take triptans when I have something I have to do and O2 is not getting it done. 

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Mit

I think it is different for every person. I was taking sumatriptan in pill form 3 or 4 times a day mixing in at least 2 auto injectors on alot of days at one point a few years ago and I think that DID give me rebound attacks. If you are not taking that much per day I think you will be fine for the 3 days. BUT that could be different for you. If you are splitting injections or taking it only one time a day you should be fine short term, I think it is when you take a lot over a longer time they will backfire. 

If you can try the 5hr energy drinks they can sometimes kill off a attack for me if I catch it fast enough and they do not keep me awake at all. 

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Hi there! I just wanted to share my latest update.... After 1-2 clusters every day for over a month I am now 5 days cluster free!!! Woohoo!! I couldn't get in to see a Neurologist until March so I started the vitamin d3 regimen (thank you so much to Peter Batcheller!!) and I also got botox injections. I am fortunate to have a friend who is a cosmetic nurse so she gave me a very discounted price. If you are struggling I would strongly recommend trying these options, anything is worth a try to save the misery of clusters! This forum has also helped me immensely, there is more knowledge here than any of the doctors I have seen in the last 15 years! Thank you & good health to you all! 

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