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Question about overuse: is it based on days or amount?


TripleToe
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I've had CH about 5 yrs ago and 5 yrs. before that. I'm having another round during the past 2 weeks.  I found that tripans really stop them in their tracks.  I've also found that I do not need much at all to knock them out.  My doctor gave me 100mg tablets, but I've been breaking them up as I've found that I need 25mg or less per day to get them to stop.   So my question is this: is the "medication overuse" problem with triptans related to the number of days I use triptans to stop the CH or does the amount I'm using also factor in?  What I mean is, should I worry about overuse problems if I'm taking such a small amount? Or is it just that stopping CH with any amount for more than 10 days is a problem?

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Overall, I'd say you are not incurring any overuse risk, particularly if it's sumatriptan that you're using.  Sumatriptan has a very short half-life, so your daily 25mg is fully out of your system before your next dose.  I don't know whether you're messing with anything significant by breaking them up, but I would think not. (They do come in 25mg doses.)

You are very fortunate!   We rarely -- if ever; I don't remember it happening at all -- see anyone here who stops a CH attack straight off (or at all) with any dose of a triptan tablet, let alone a dose that small.  Even with migraine, where the tablets are sometimes effective, it usually takes a while for a pill to have an effect.

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16 minutes ago, CHfather said:

Overall, I'd say you are not incurring any overuse risk, particularly if it's sumatriptan that you're using.  Sumatriptan has a very short half-life, so your daily 25mg is fully out of your system before your next dose.  I don't know whether you're messing with anything significant by breaking them up, but I would think not. (They do come in 25mg doses.)

You are very fortunate!   We rarely -- if ever; I don't remember it happening at all -- see anyone here who stops a CH attack straight off (or at all) with any dose of a triptan tablet, let alone a dose that small.  Even with migraine, where the tablets are sometimes effective, it usually takes a while for a pill to have an effect.

Thanks for the response.   It could be that mine are just smaller ones perhaps but that's just a guess.  I have found it takes much longer to subdue the headache if I let it really get going, or especially if I take the triptan on a full stomach.  I've only had maybe 2-3 "clusters" over the last 10-12 years and they seem to disappear after 2-4 weeks so I'm hopeful that will happen here.   Given the pain that some of the posters on this forum have gone though, I do feel fortunate so far.   I've asked my doctor about also getting O2 to see if that would help without resorting to the triptans.  I just wanted to be sure I wasn't getting into the overuse category and it wasn't clear if it was based on the number of milligrams consumed vs just the action of using them that counted as 'overuse'.   I appreciate your input.

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3 minutes ago, TripleToe said:

Thanks for the response.   It could be that mine are just smaller ones perhaps but that's just a guess.  I have found it takes much longer to subdue the headache if I let it really get going, or especially if I take the triptan on a full stomach.  I've only had maybe 2-3 "clusters" over the last 10-12 years and they seem to disappear after 2-4 weeks so I'm hopeful that will happen here.   Given the pain that some of the posters on this forum have gone though, I do feel fortunate so far.   I've asked my doctor about also getting O2 to see if that would help without resorting to the triptans.  I just wanted to be sure I wasn't getting into the overuse category and it wasn't clear if it was based on the number of milligrams consumed vs just the action of using them that counted as 'overuse'.   I appreciate your input.

I suppose it could also be the situation that I'm just having a session of migraines vs true CHs.  Not sure how they differ to be honest.

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Hi TT....welcome aboard...

.... OXYGEN combined with energy drinks/high caffeine drink and the D3 regimen and you might could eliminate the triptans altogether. kinda dependent on how long your cycles last and their frequency. even with your short/infrequent cycles it would be good info in the bank for future reference....CH mutates regularly...

....for that low a dose, and an oral to boot, to be that effective as what sounds like a prevent, is most fortunate. all exceedingly rare and good on you for dialing it in like that...

....rebounds are a pretty individual dependent. generally, the higher the dose the more likely rebounds (not a given).  usually reported as more frequent hits, and/or at odd times, and/or with different intensity than your typical pattern. only real way to find out is comparing a log of hits with and without triptans....tho with enough experience gut feel probably sufficient.  agree with CHf as unlikely for a dose this low...

best

jonathan

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3 hours ago, jon019 said:

Hi TT....welcome aboard...

.... OXYGEN combined with energy drinks/high caffeine drink and the D3 regimen and you might could eliminate the triptans altogether. kinda dependent on how long your cycles last and their frequency. even with your short/infrequent cycles it would be good info in the bank for future reference....CH mutates regularly...

....for that low a dose, and an oral to boot, to be that effective as what sounds like a prevent, is most fortunate. all exceedingly rare and good on you for dialing it in like that...

....rebounds are a pretty individual dependent. generally, the higher the dose the more likely rebounds (not a given).  usually reported as more frequent hits, and/or at odd times, and/or with different intensity than your typical pattern. only real way to find out is comparing a log of hits with and without triptans....tho with enough experience gut feel probably sufficient.  agree with CHf as unlikely for a dose this low...

best

jonathan

Thanks so much Jonathan. I’ve got a dr appt next week to see about getting an o2 canister as that seems to be the best option to bypass the triptans.  I haven’t done much research on D3 but I’ll definitely check it out. Nice to get this type of feedback for sure!

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22 hours ago, TripleToe said:

I suppose it could also be the situation that I'm just having a session of migraines vs true CHs.  Not sure how they differ to be honest.

One simple way that they differ is that while people with migraine can generally go lay down in some helpful situation (dark, quiet  room, damp cloth on forehead, etc.), people with to CH are too agitated to do that (and it doesn't help the pain). Agitation -- pacing, rocking, etc. -- is a clinical sign of CH.  This is pretty generally true, even in milder versions of CH.  Since you say that in some situations it your attacks can last for a while, maybe you have experience.  At the most basic level, medical preventives and abortives for CH and migraine are the same, so it might not matter all that much.  O2, however, is generally not effective for migraine.  The D3 regimen is a preventive that helps with both.

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