Sumatripton help

[Henrithree]

My healthcare provider is giving me a hard time about my sumatripton prescription.   I was wondering if it is possible to become dependant or abuse this type of medication?  Does is cause more headaches to occur?  Does it make episodic clusters last longer (longer cycles)?  I know this medication helps me short term,  but is it making it worse in the long term?

[Freud]

The answer is yes, there is a daily maximum amt of sumatriptan one can safely consume for injectable it’s 12mg. Depending on which injectable you use that could be 2 shots or 4 shots (zembrace). The triptans are a double edge sword. They have been shown to increase severity and number of attacks. Several people have posted they think they went from episodic CH to chronic CH from excessive sumatriptan use. There are also heart precautions with high usage. It’s not a totally benign Rx, but it feels like it’s gods gift to CH. 

Edited March 7, 2019 by Freud

[Siegfried]

Hi Henri,

ICHD-3 has defined headache type 8.2.2 which is Triptan-overuse headache. So if you want to be on the safe side, that is definitely something to look out for. 

Also important is your personal situation - if you are around 60 yrs of age or have a tendency for high blood pressure that is not under control, that is also an indicator to be extra careful. See Freud his reply as well. That is spot-on.

Best Regards !

siegfried

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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.

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[Pebblesthecorgi]

I agree with what the others have said.  The very nature of triptans is to abort an attack.  Oxygen is a safer bet but of course has its own challenges and does not always work.

 

Oral imitex is basically useless as a cluster aborter so you are left with injectable.  Though caution should always be used and cardiac conditions should be treated first triptans are generally safe when properly used and doses limited.  Rebound headaches are an uncommon but real occurrence  and generally occur when the drug is used beyond suggested doses.  Yes there are some reports of folks going chronic both on the forums and in the literature. as case reports.  There isnt enough controlled data to say for sure.

 

Even though imitrex can be "life-saving" its inability to bust a cycle or act as a known preventative makes it second best.  Busting measures and  D3 should be considered.

 

Now cynical me has a response to your doctor giviing you a hard time.  This is more likely due to the cost of the drug.  he pharmacy spend on triptans is significant and treatment linitations are based on migraine headache folks.  Clusters need to be addressed in a different way but the insurance doesn't recognized the difference.  Most episodics who coose to use imitrex horde it while out of cycle so they have enough to get through the next cycle. 

[Freud]

Valid points made by all. I forgot who it was but one of the regular posters was talking about the initial trials of imatrex and heart attacks. Hopefully some one will chime in. 

The other problem is most insurance companies will pay for 16-20 injections a month I have min of 60-90 CH a month. Sadly my insurance only covers them at 50% making them unaffordable. But when I got my 2 month break from busting. I stockpiled 40 injections. I save them for important days/ family or friend functions when I don’t want to be toughing it out.