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Topic: Can Imitrex Cause Rebound HA's? (Read 1214 times) |
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RAJ
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Can Imitrex Cause Rebound HA's?
« on: Mar 31st, 2003, 3:17pm » |
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My cycle is currently running one month longer than ever before and I find myself wondering if I'm in a rebound mode from Imitrex. Does anyone have experience or know if this is possible. O2 and Trex still provide relief. I'm half tempted to stop treatment to stop this madness, but don't think I could do it. I am so tired of this &%$#. Any input appreciated. Thanks.
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amber
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Re: Can Imitrex Cause Rebound HA's?
« Reply #2 on: Mar 31st, 2003, 3:46pm » |
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but ueli.... 
can't you get dependant on it, causing an increased need for the medication? I have read some info on that an sumatriptan.
I know that my doctors were concerned that I was using it too often and that it was indeed causing some of my headaches.
signed,
concerned headacher 
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Nathan
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Re: Can Imitrex Cause Rebound HA's?
« Reply #3 on: Apr 1st, 2003, 9:22am » |
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i had serious rebound headaches from imitrex nasal so my neuro took me off of it. of course, i had to use it daily, at least one a day if not more. people that are able to use it as directed (no more than 3 times per week) should have no rebound effect.
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Wendy1
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Re: Can Imitrex Cause Rebound HA's?
« Reply #4 on: Apr 1st, 2003, 2:00pm » |
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When I took Imitrex about 6 yrs ago, I had a h/a EVERY 3-4 HRS vs. my nightly 1 or occaisionally 2. Never before had I had so many and at times (during the day) that I had never had before. My doctor took me off it because it is VERY UNSAFE to use that much in 24 hrs ~ you'll have a heart attack! Incidently ~ Imitrex worked WONDERS for me.  My opinion in my case it was DEFINATELY REBOUND!
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achinghead
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Re: Can Imitrex Cause Rebound HA's?
« Reply #5 on: Apr 1st, 2003, 5:00pm » |
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how much are you taking and how often.. Im going through 2 -6mg vials a day.. sometimes they last 2 days.. Im using the imitrex tip on the left and Im getting 2-3 per vial.. I hate using that much esp since Im paying outta pocket... but if I dont Im afraid I wont be here.. Cant deal with the pain.. anyhow.. Im beginning to wonder the same thing my self.. I just got 02 today so Im gonna try it and hope it works.. I just have so much trust in the trex that its hard to trust anything else.. we will see.. Im keepin my fingers crossed that it works for me.. let me know how much of the trex ur using
good luck
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Wendy1
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Re: Can Imitrex Cause Rebound HA's?
« Reply #6 on: Apr 1st, 2003, 7:05pm » |
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Well at the time I did not know about the Imitrex 'tip'. It was really hard for me because it took my h/a away, but I had so many bruises from the injections, it was almost embarrassing. The fact the I could die and was getting MANY MORE outweighed the fact that it helped my h/a. Right now I'm taking Verapamil, Amerge and Vicodin and sitting with the beast for an hour. I'm dieing, right now the beast has complete control over my days!!!! AAAAHHHHHHHHHHGGGGGGGGGGG
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Ueli
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Re: Can Imitrex Cause Rebound HA's?
« Reply #7 on: Apr 1st, 2003, 7:41pm » |
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Something about rebound and dependence.
It is a well known fact that many OTC pain meds as well as narcotic pain killers can use rebound headaches. When used on a regular basis these meds enter the brain and on reducing them again withdrawal effects manifest themselves as a continuos headache, the rebounds. These rebound headaches are usually less severe than the one that led to the overuse of painkillers, but are annoying through steady presence.
Imitrex, and all the other triptans, act as vasoconstrictors. Their lifetime is so short that they never enter the brain and therefore have no addiction potential. This short life is also the cause that 2 hours after an Imitrex shot another attack may raise its ugly head. And that it is: another attack, nothing at all to do with a "rebound".
Wendy1, the fact that in one cluster bout you had more attacks than in others is something many clusterheads experience. The fact it was the bout you took Imitrex is not sufficient to postulate a correlation; or did you go in between a few days without Imitrex and the number of attacks dropped?
Now the old question, how much Imitrex is save take. As I have said often before, to get FDA approval the manufacturer must show the safety for the typical user, and 4 per month a more than enough for the typical meegrainer. Some insurance companies try to interpret this as an upper save limit, for an obvious reason. Likewise, some doctors want to save their ass by an unreasonable restriction. There are many clusterheads that have taken a hundred Imitrex shots in a month, and are still kicking.
What about he danger of heart disease? Here the answer is very easy: For people with certain heart conditions Triptans of any kind are a no-no. For people with a healthy heart there is no hint in the literature that even extended Imitrex use does favor the development of heart diseases.
If you had opened the link I gave in my first post, you had read about the lack of rebounds from Imitrex (and even its use to get red of rebound from pain meds), about the "overuse" and lots more. ;D
For your convenience, here's the link once more:
OUCH Library: About Imitrex Rebound
And while you there, take a look around, BobP has collected a lot of useful stuff in the OUCH research library.
PFNADs
Ueli
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Wendy1
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Re: Can Imitrex Cause Rebound HA's?
« Reply #8 on: Apr 2nd, 2003, 7:48am » |
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Ueli....
My cycles (20+ yrs) have always been pretty predictable. Only with the Imitrex did I have them coming 3-4 hours after the imitrex ~ out of nowhere. There is no doubt in my mind it was caused by the imitrex. I have had 3-4 cycles since and have not had them as frequent. I did read the bit about Imitrex and rebound. a) any one other than the pt will not admit to rebound. b) call it what you may, I believe some ppl do receive a rebound effect from Imitrex ~ others may not.
Trust me, I have researched just about e/thing there is to research and been to every h/a clinic in the east. Thanks for your input though.
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RAJ
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Re: Can Imitrex Cause Rebound HA's?
« Reply #9 on: Apr 2nd, 2003, 7:51am » |
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Ueli,
My apologies for overlooking the link you posted originaly. Thank you.
My confusion lies from other information indicating it is possible with migraine folks. The paragraph posted below is from a website for Dr. David Haas of SUNY. Most of the stuff I have found suggests it can for migraines but not for cluster. (Hence my confusion).
http://www.upstate.edu/neurology/haas/hpaadx.htm
Folks who take analgesics, ergotamine, triptans, or any other type of drug frequently for several consecutive weeks to alleviate migraines or episodic tension-type headaches risk inducing a chronic daily headache.
I utilize the trex tip from this site and find that 3mg is sufficient almost all the time. This is particularly helpful as I have reached my limit with my insurance (started the appeal process). I have taken up to four 6mg doses in one day with no problems but very much try to stay in the 2 to 3 range. Once again I'm hoping that I'm nearing the end of this cycle as I'm down to two attacks per day and O2 alone helps with the moderate one which is 5 am. The 1am attack is still to severe.
Wendy1: My personal experience with Vicodin is not a good one. While effective in providing relief, albeit slow to take effect, I have no doubt that "for me" it caused a rebound situation. Many, many years ago, I had to have in-patient DHE treatment to break a cycle which developed non stop migraine on top of CH. Never going there again! Be careful.
Best of luck to all. "May it pass quickly!"
RAJ
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Wendy1
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Re: Can Imitrex Cause Rebound HA's?
« Reply #10 on: Apr 2nd, 2003, 7:58am » |
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RAJ ...
FORTUNATELY for me, I have been lucky enough that Vicodin does not cause a rebound. You're right it was an hour+ this am, but at least I know the pain will be gone in an hour. I am out of my Amerge, my gp is out of town and my F------ neuro won't see me until the 14th (what's with that!!). I am working very, very hard on relaxing and pressure points right now. (Remembering 'we do not want to go to ER, we do not....) LOL. I am absolutely dying with these things right now...
ANY SUGGESTIONS ANYONE!!
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Lenny
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Re: Can Imitrex Cause Rebound HA's?
« Reply #11 on: Apr 2nd, 2003, 8:30pm » |
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According to my doc ( and he is very familiar with our disorder and well known) ,"YES", imitrex can cause rebounds,
I for one love (trex) its the only thing out there that will help me as far as aborting the beast. In the past i have used it on many occasions 6-7 times in a 24 hour period with no ill effect ( full 6-mg.each time ),the past 2 years i have been using 2-mg.each time( works just aswell as 6-mg.- sometimes takes a little longer,thats alright as long as it does the job ).
Of course GlaxoWellcome does not have that in their literature ( btw-this will help abort your headache-but dont use too much-it can cause rebounds = they are in it for the$$$$$  ).I have been told by him atleast 4 or 5 times regarding this ( "that trex causes rebounds" ). As far as the literature ( bullshit ), just like( as an example ) "cluster-traits"( on this board ) saying that episodics cycles last 6 - 8 weeks and then goes into remission( when i was episodic,all of my cycles lasted from 8-9 months,each and every time) i guess what i am trying to say, dont beleive half the b.s. you read regarding our disorder ( all these so called "GURU"docs are still trying to figure it out. PFDAN to all.
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RAJ
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Re: Can Imitrex Cause Rebound HA's?
« Reply #12 on: Apr 3rd, 2003, 7:58am » |
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Thanks for your input Lenny.
I too have found 2 - 3 mg to work...it does take longer, but it allows me to stretch the med, which is important as I am now in the middle of an appeal with my insurance company. At least my Dr keeps me supplied with professional samples in the interim. I have also found that with the lower does, my cycle may be coming to an end which might support the notion of some "rebound". PFDAN to all.
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cluster0557
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Re: Can Imitrex Cause Rebound HA's?
« Reply #13 on: Apr 13th, 2003, 2:52am » |
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Yes Imitrex has caused me rebound headaches. I cannot take it two days in a row.
So irregarsless of studies Uli mentions I know it does and have had to delal with it.
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Pain is Inevitable, Suffering is Optional
Life is too short so push thru the _amn pain.
Jim
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Ueli
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Re: Can Imitrex Cause Rebound HA's?
« Reply #14 on: Apr 13th, 2003, 10:14am » |
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I wish not everybody would give a new definition, to his/her own liking, to a long established expression. Damn it. 
There are cluster headaches and other headaches.
If you abort a cluster attack with an Imitrex shot, there can be different outcomes:- The attack is aborted for good; the next one comes several hours later, probably at the expected time.
- The attack is aborted, but the same/another hits you after about 2 hours:
- You aborted a monster attack that on it's own had lasted 3+ hours. Imitrex last only for about 2 hours, so it is possible that the original attack re-surfaces again.
- A new attack starts. It is not unusual that 2 hours after the end of an attack another one starts.
So it could be someone experiences more cluster attacks when using Imitrex, but one thing is certain: these are NOT rebound headaches !
I assume y'all know the difference between a cluster headache and any other sort of headache. The term "rebound headache" is reserved for the low level, but continuous headache caused by overuse of painkillers, OTC or narcotic. Painkillers interfere with the transport and processing of pain signals, and can therefore cause a rebound headache. Imitrex works in an entirely different way than painkillers, and for this reason alone can not cause rebound headaches.
So, I we stick to the original definition of the words, it still holds:
Imitrex does not cause rebounds
PFNADs
Ueli
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cbolony
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Re: Can Imitrex Cause Rebound HA's?
« Reply #15 on: Apr 13th, 2003, 10:25am » |
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Quote:these are NOT rebound headaches !
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Ueli you are right i use to think these were rebounds,but no rebound can cause the same CH 3-4 times a day at 8-10 kips for 4-5 weeks of my cycle and then start coming down to lower kips till the the cycle ends in about 8-9 weeks
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cluster0557
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Re: Can Imitrex Cause Rebound HA's?
« Reply #16 on: Apr 13th, 2003, 1:13pm » |
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Ueli,
I will agree to disagree.
My clusters are normally 6-7 hours (2-3 per day) between attacks.
If I use Imitrex 2 days in a row, (only twice a day) my clusters start occuring more often. Like every 3-4 hours (4-5 per day)
Now this in your opinion is not rebound. In my Neuro's and my opinion it sure seems like a rebound.
I went back to maxalt for 2 weeks and no rebound symptom. Of course Maxalt and 20-30 minute abort time sucks so I am back to Imitrex and watching closely how much I use.
To minimize my non-rebound I went to vial and smaller dose and guess what.....................
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Pain is Inevitable, Suffering is Optional
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Jim
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Bob P
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Re: Can Imitrex Cause Rebound HA's?
« Reply #17 on: Apr 13th, 2003, 8:06pm » |
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Here are the symptoms of rebound headache:
daily or nearly daily headache
pain on both sides of the head
pressing/tightening quality ("like a tight belt around my head"
perhaps a mild degree of photophobia (sensitivity to light) or phonophobia (sensitivity to sound)
tight and tender neck and shoulder muscles
the patient is regularly taking symptomatic/abortive pain medication
Ueli is correct, a cluster headche is not a rebound headache, it's just another cluster headache. Rebound headache is a specific headache with the above symptoms. It is cured by stopping taking medications.
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cluster0557
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Re: Can Imitrex Cause Rebound HA's?
« Reply #18 on: Apr 13th, 2003, 8:20pm » |
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hey you win the contest.
OK isn't the climical definition of rebound.
Answer me this. Why fo they reccomend limiting triptans to x days use a week?
Every quack Neuro I have seen has said rebound but heck I am a rookie what do I know
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Pain is Inevitable, Suffering is Optional
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Jim
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Ted
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Re: Can Imitrex Cause Rebound HA's?
« Reply #19 on: Apr 13th, 2003, 9:04pm » |
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I have a suggestion 0557. You're asking questions that you can find the answers to by clicking on the buttons to the left of the board or hitting the OUCH library. Why not just do that instead of giving an attitude to those trying to teach you so you don't have to do your own legwork of researching. And yeah. When it comes to certain headaches, some here are much more informed then many neuros, including those you're giving an attitude to.
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| « Last Edit: Apr 13th, 2003, 9:06pm by Ted » |
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cluster0557
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Re: Can Imitrex Cause Rebound HA's?
« Reply #20 on: Apr 13th, 2003, 9:36pm » |
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Ted,
Someone is very sensitive today. If that was giving attitude ok I will reserve my comments and when I disagree I will remember freedom of speech is not tolerated here.
When I thought about my "rebounds" I realized I did not get into what types of HA I have.
To UELI and BobP I apoligize. My own research says you are correct in the clinical sense.
For me frequent use of Imitrex seems to bring on Migraines, not clusters with me. According to my Neuro he called this rebound and that is what I was quoting.
The OUCH study seems to support that.
To UELI and BobP again thanks for correcting my misinterpretation.
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| « Last Edit: Apr 13th, 2003, 9:49pm by cluster0557 » |
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Pain is Inevitable, Suffering is Optional
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Jim
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eyes_afire
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Re: Can Imitrex Cause Rebound HA's?
« Reply #21 on: Apr 13th, 2003, 9:49pm » |
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Hi Cluster0557. The main reason for the dose limit is because during clinical trials the drug company didn't set up the study to include more frequent dosing. Since imitrex is primarily marketed as a migraine medicine there was no reason for the drug company to set up the clinical trials for every-day dosing (or more). Clinical trial applications are submitted to the FDA based on the intended usage of the drug product. Therefore, some docs are reluctant to prescribe it more frequently, not necessarily because it is unsafe, but simply based on the clinical trials.
Another thing to consider... many of the insurance companies would love for us to believe that imitrex causes 'rebound cluster headaches' (if there is such a thing) because it gives them an excuse for limiting what they would pay for. If your medical and prescription plans are covered by the same company, maybe the insurance company is pressuring the doc to limit imitrex prescriptions. Who knows.
In my opinion, a doc that argues to limit imitrex due to fear of true rebounds (as per Ueli's description) is not being reasonable since the CH if MUCH WORSE than any rebound.
Now, having said that, it would not surprise me if after much use of imitrex, maybe the body becomes 'used to it' and maybe more frequent doses would be required. Such an occurence would probably more properly be called 'a worsening of the CH condition' rather than 'rebound headache'.
Such are the pitfalls of being the victim of an 'orphaned disease'.
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cluster0557
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Re: Can Imitrex Cause Rebound HA's?
« Reply #22 on: Apr 13th, 2003, 10:17pm » |
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Hi eyes_afire,
I am lucky because I don't have a predetermined limit per month on Imitrex or Maxalt. My Neuro has given me scripts to cover both in the needed quantity per month. For me it is only a matter of deductibles. I used to use Maxalt but have been using Imitrex since I went chronic a long while ago;
As to amount typically reccpmended per day and week you hit the nail on the head. The clinical trials for migraine said x pills per day to not exceed y pills per week. And as you so eloquently stated those trials did not apply to cluster even though Imitrex is the # 1 abortive for Cluster.
Thanks for getttng my mind functioning again.
on Apr 13th, 2003, 9:49pm, eyes_afire wrote:Another thing to consider... many of the insurance companies would love for us to believe that imitrex causes 'rebound cluster headaches' (if there is such a thing) because it gives them an excuse for limiting what they would pay for. If your medical and prescription plans are covered by the same company, maybe the insurance company is pressuring the doc to limit imitrex prescriptions. Who knows.
Such are the pitfalls of being the victim of an 'orphaned disease'.
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Pain is Inevitable, Suffering is Optional
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Jim
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RAJ
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Re: Can Imitrex Cause Rebound HA's?
« Reply #23 on: Apr 14th, 2003, 7:10am » |
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Perhaps my next posting should be: "Are CH patients typically Type A personality and highly opinionated?" Geez folks....we share the same burden. Be willing to share information and even an opinion, but don't beat someone over the head with it let alone demean them for their postings. Everyone needs to remember these are just opinions, albeit highly educated ones. Sure there are a lot of quack neuro's out there, but there are also a lot of highly trained competent ones. Someone visiting this site that is looking for more than an opinion needs to seek out a competent neuro. I asked my neuro this question when I visited him last Thursday. He is certified in neuro & pain management, previous instructor at John's Hopkins and runs a HA clinic with quite a bit of CH experience. He believes that any abortive medication can cause rebound and imitrex certainly can present elements of this. As mentioned above, rebounds are distinctly different from CH. My experience (and I stress; my experience) is when I'm coming to the end of my cycle, the CH attacks begin diminish in frequency and I begin to experience some rebound "head" pain (KIP 3-5/dull in nature). Once the CH cycle is over, I begin to eliminate all pain meds to get rid of the rebound.
Oh, and one last thought...what’s with all the apologies to the highly opinionated folks. Certainly years of Kip 10 pain has given them a tougher skin than that.
PFDAN to all.
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Lenny
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Re: Can Imitrex Cause Rebound HA's?
« Reply #24 on: Apr 14th, 2003, 9:50am » |
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This past sept. i went a full week without using any trex  just to see if the # of attacks would reduce.
Prior to doing this,i was getting 6-7 attacks per day.That week without the trex.,i avg. 3- attacks per day. Went back on the trex.,the first 2-days ( if i recall correctly ) i was getting 3- a day and then back to 6 a day.These were full blown clusters ( not what Bob described ) now dont get me wrong( I AM IN "LOVE" WITH TREX  ) as far as the word REBOUND goes,that is what my doc calls them and as i mentioned above claims that too much( trex) causes them ( i forgot what his def. is too much ) . This is my personal exper. with this medication.
Could you guys please share with us your exper. with this med.
1- how long you have used it ?
2- how many attacks per day ( prior to using it ) ?
3- how many attacks per day ( while using it ) ?
4- did you inj.yourself each time ?
5- I sure hope none of you take this as a personal attack on you ( that is not my intention ) i just want to know your exp.with this.
I thank each of you in advance for your responce ( reg.your personal exp.using IMITREX INJ.) and will jump back on sometime in the afternoon ( at work ;D ;D )
PFDAN to all
p.s. Ueli - Please dont use those big words ( i wont be able to understand ) ??? ;D ???
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