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        New Message Board Archives >> Medications, Treatments, Therapies 2002 >> Re: rebounds?
        
(Message started by: dannyboy on Mar 1^st, 2002, 5:35am)

Title: Re: rebounds?
Post by dannyboy on Mar 1^st, 2002, 5:35am

Simply when the drug you're taking for your headaches (Clusters/migraines/etc) causes your headaches to get worse in either intensity, frequency or both - is the well accepted explanation, but that's just conceptual.

If you you get hit should you dare to skip a dose of your medication on a constant basis ... there's a good chance you've got rebound - is one of the accepted ways of diagnosing.

Alternatively you're chronic .... kind of a grey area...hmmm

I'm pretty sure some of the main cluster meds (imitrex and the rest of the triptans) have been shown to be implicated in causing rebound, the shocker is obviosly whether it could be implicated in converting an episodic into a chronic over long periods of use? The possiblity is really too terrible to contemplate though because its the only form of pain relief for many? Is there a God..........?

Clinically though, I'm not sure rebound has been very accurately isolated.

There's many more definitions and defining factors but thats the very very basics - Ueli is probably your man for more detailed and specific info, mail him.

Catch you on the rebound

Not Funny
Daniel

Title: Re: rebounds?
Post by Bob_P on Mar 1^st, 2002, 9:58am

Here's a link to some info in the OUCH Library:
http://www.clusterheadaches.org/library/medications/imitrex_rebound.htm
http://pahlow.net/images/ouch.gif

Title: Re: rebounds?
Post by DavidGoldberg on Mar 1^st, 2002, 9:59pm

I got no rebound with Maxalt. Try it you'll love it.

Title: Disregard the post of Dannyboy
Post by Ueli on Mar 3^rd, 2002, 9:16pm

Dannyboy, with his quarter assed knowledge of medical stuff, is once more muddling up everything.

Regular pain meds and narcotics are acting on the pain receptors and the pain transmission path. An overuse and/or withdrawal can result in rebound pains.

The Triptans, ergot compounds and oxygen used in aborting a CH are not interfering with the sensation of pain; they break the feed back loop involving expanding vessels. Therefore, if you experience another cluster attack some time after using one of the above it is just that: another cluster attack.

And anyway, 'rebounds' from overuse or withdrawal of pain meds or narcotics are related to a cluster attack like a gentle breeze in May to a tornado or hurricane.

As the link given by BobP says: There are no cluster rebounds from Triptans!

And from this, David, follows that there are no rebounds from Maxalt (Rizatriptan).

PFNAD, Ueli

Title: Re: rebounds?
Post by susan on Mar 4^th, 2002, 3:52am

Yeah I figured that out all on my very own, smart ain't I? ;)

Title: Re: rebounds?
Post by jnesbitt on Mar 4^th, 2002, 6:53am

My experience is pretty much the same as the others. Rebounds from pain meds, Sansert, the ergots, and probably lithium. No rebounds from anything else, especially oxygen. And the rebounds are "cake" to deal with compared to the clusters. Aspirin or Motrin work well for me there. Also, found that tapering the medication at the end of the cycle (there is the rub)worked well to minimize the rebound. Good luck!

Title: Re: rebounds?
Post by Richard on Mar 4^th, 2002, 9:48pm

I hate to disagree but, I just came off of a 3 day rebound from taking maxalt for 4 weeks. What was said earlier is true, the rebound isn't nothing compared to the real beast. Esgic-plus actually helped stop the 3 - day ringing in my head :o. Some quality of life we live , ???

Title: Re: rebounds?
Post by justin on Mar 7^th, 2002, 9:39pm

rebounds for me are shorter and weak, like kip3 and only last about 15 mins, but i'll get them like every hour. where as i normally only get two kip8-10 CH per day in a strong cycle. only really got bad when i was taking vicodin twice a day before i had imitrex. although imitrex will do the same thing sometimes. now i reach for O2 instead of vicodin whenever i can and it's not bad enough to warrant using a precious imitrex injection. peace out all

Title: Re: rebounds?
Post by reelboat on Mar 7^th, 2002, 11:38pm

Call it what you will, I get rebounds from Imitrex and did from egotimine. They are different in the fact that they occur every two hours and will last for an hour. Thats 12 CH's per day. The way I break the cycle is to go a few days without any medication. This breaks the rebound cycle and I go back to 4 - 5 day. To prevent a reoccurance of rebounds I have to accept at least one HA/day with no aborting medication. Not the easiest thing to do with a closet full of Imitrex. This has repeated on at least 3 different occasions including my present state.

Title: Re: rebounds?
Post by kim on Mar 9^th, 2002, 2:55pm

I went through several rebound episodes throughout my ch history. They were especially tough when taking pain meds. Went to the hospital with uncontrollable vomiting (on top of consant ch attacks) it was awful. Now i try to avoid pain meds altogether if possible. Its a catch 22. You desperately want to end the pain, but it could actually making your situaion worse. I do not recall rebounding from any of the other medications i have taken. Its hard to pinpoint. Sometimes the ch attacks are so severe, you don't know if your up or down - your just flopping around with it until it ends. Its the BOSS!

Title: Re: rebounds?
Post by dannyboy on Mar 11^th, 2002, 6:55am

Hmmm ... Thomas from Munich seems to know alot about these type of things too. Does anyone know how to get hold of him?

Thomas are you there?

Title: No wonder Dannyboy
Post by Ueli on Mar 11^th, 2002, 7:50am

No wonder Dannyboy,

in contrast to you, who got your medical "knowledge" from a few articles in "Readers Digest", Thomas is a full grown medical doctor.

BTW, why don't you try to access his profile?

Title: Re: rebounds?
Post by Linda T on Mar 11^th, 2002, 10:12am

So now you guys have got me totally confused!

Rebounds or not?

This is the first cycle where I'm using imitrex. My neuro gave me 50mg tabs. I find that if I take 1 50mg take at the onset of my first ch at around 10p and stand in the shower its over by 10:30. Then I can sleep through till the next one at 6a. I don't take anything then, just stand in the shower and it's also over about 30 minutes later.

Last night I didn't take anything at 10 and got hit at 3a. Took the imitrex then and didn't get the 6a one.

Every few days I get hit between 1p and 2p but that's the exception rather than the rule.

My problem: This cycle is going on 4 months now. Never had one this long. Trying not to think about the C word. Can I be bringing this on myself with the imitrex? Am I taking a high enough dose to cause rebound? If so, I'll try not taking the imitrex as hard as that will be. I am also on 500 mg on depakote going on 2 weeks now with no significant result other than I do think the intensity is less on the kip scale, say 6 or 7.

Any feedback?

Title: Re: rebounds?
Post by kim on Mar 11^th, 2002, 1:31pm

Hey Linda, I'm sorry you are having a longer cycle. Don't project. It could simply be a more bullish cycle. I also was prescribed Imitrix with Depakote (+ midrin) with not very good results. I think it has a lot to do with the time you BEGAN taking the medication and how much of it you are taking. Are you seeing a neurologist? Are you keeping a diary or schedule of attacks? I think these all factor in somehow. Once a cycle of ch is full swing it is extremely resistant to ANY medication. As far as the rebounds go, i can only say that i've only gotten them from narcotic pain meds, not anything else. Ask the doc. Wishing you well!!

Title: Re: rebounds?
Post by Tom on Mar 11^th, 2002, 2:47pm

;)

Hi Dannyboy, hi Ueli,

I wouldn't claim to know "a lot" about Rebound Headaches (=RHA)...but let's define this term again in a simple way:

RHA are HA you get in addition to your regular ones and that you wouldn't get without (over)using a certain drug.
-----------------------------
Please look under the following URLs for more informations about RHA (and you certainly can find much more infos in the Google):

www.upstate.edu/neurology/haas/hpaadx.htm
http://freedomfromheadaches.com/headache_files/hdfiles_imitrex_bern.html
www.migraines.org/new/news9902.htm = one of the best ones !!!!!!!!!
www.clusterheadaches.org/library/medications/imitrex_rebound.htm
-----------------------------

As far as I know:

- it counts as valid that almost all analgesics and also ergotamine
cause RHA in migraines but don't so in CH.

- most articles about RHA and triptans refer to migraines.

- even regarding migraines I couldn't find only one article that
would prove in a scientifically/statistically correct way that
triptans cause RHA.

- many neurologists don't agree that triptans provoke RHA even in
migraines.

- triptans are even used for detoxicating migraneurs with RHA from
other drugs.

- CH specialists seem to agree that (until now) there is no
evidence of triptans (and ergotamine, too) causing Rebound
Cluster Headache.

- as far as I know: Until now there is no scientific evidence of a n y
drugs causing RHA in CH (exception: The triggers alcohol +
nitroglycerine etc : They certainly do, as we know...!)

- concerning all drugs: It's not recommendable to view occasional
individual "findings" and impressions as "facts" and thus blame
for example the triptans to cause RHA (as already happened with
verapamil, if I remember well).

Here I would like to quote an episode from:
http://freedomfromheadaches.com/headache_files/hdfiles_imitrex_bern.html :

Dr. Bernstein: Probably, there are people who take Imitrex everyday who develop headaches when the Imitrex wears off. So, then you have to go back and ask are they taking Imitrex for the right headache and when the Imitrex wears off do they then take two Excedrin or three Tylenol. Patients don't always report to their physician how much non-prescription medication they take. They always talk about how much Imitrex they are taking but may not realize how important it is to report non-prescription medication.

Here is a typical scenario:
Patient- "My Imitrex is down to three a week."
Doctor- "So that's great, what are you taking in between?"
Patient-" Well, I just take Excedrin."
Doctor- "How much Excedrin?"
Patient- "Oh, I take two".
Doctor- " How often do you take two?"
Patient- "Every three hours".
Doctor- "That's 16 a day".
Patient- "Yeah, that's about right. I take it everyday. I get up in the morning and I take it, as long as I keep taking it I'm okay. Then every now and then I really get nauseous and vomiting and I take my Imitrex."

Something is wrong....what's wrong with this picture? This person was sent by a neurologist who was treating their "migraine" and had gotten her down to three Imitrex a week which is still a lot. But she still had daily headaches. Nobody discussed the use of non-prescription medicine, and this is often not in the medical records and patients generally don't volunteer this information.
-------------------------------

Another quoting (unfortunately refering, as mostly, only to migraines...) from: www.migraines.org/new/news9902.htm :

...rebound headache related to Triptan has n o t been established, and limits placed on such drugs interfere with a doctor's overall treatment plans.

According to Dr. Fred Sheftell, president of ACHE (American Council for Headache Education) and Director of the New England Center for Headache, "Limitation of tablets to nine tablets per month for sumatriptan, while satisfactory to most sufferers, is not satisfactory for many Migraine sufferers with high-frequency and disabling Migraine (intractable Migraine). For example, some patients may have to take three or four 50mg tablets of sumatriptan to manage one attack, and a limit of nine tablets would limit use to two episodes per month. Beyond that, when patients are denied access to enough abortive therapy, they will have to return to the emergency room where coverage is often denied, which I believe constitutes abandonment of care.
------------------------------------

I apologize for the may be oversized post and hope to don't have created more confusion than clarification with it.

PFDAN to everybody ! Thomas/Munich

Title: Re: rebounds?
Post by Elissa on Mar 17^th, 2002, 8:43am

I'm sorry!!!!!!!!!!! had to laugh at some of these responses. I mean, after awhile you have to laugh or slit your wrists! I read or saw somewhere (can't remember) a treamtent that involves putting you under anesthesia for people with chronic pain, or who are erbounding from an addiction to meds for pain..(which is what I'm going through now)..Anyone ever heard of this? My family doc hasn't and I have to wait another 3 weeks to see my new neuro.

Title: Re: rebounds?
Post by Rich D on Mar 17^th, 2002, 9:26am

I do have a problem with rebounds and have just aborted a rebound cycle, although I'm still getting 4 CH's/day. I had to go 2 days without taking any abortive medication (Imitrex). While I was rebounding I would get up to 10 CH's/day. I now am trying to limit my Imitrex to once per day. If I end up out in public when I get a couple of HA's, I'll still take the Imitrex, but I know if I take it more than a couple of times in a 12 hr period it will lead to more frequent HA's.

I sometimes wonder if its really worth it to take any of this medication. It seams that when I started with CH's, 28 years ago, I would gulp down 4 - 6 asprin and the HA would go away in an hour. I would get 3 - 4 per day and the cycle would last 1 month. Now I take several prophalatic meds and an abortive med. I end up with 4 - 5 HA's per day and the cycle last 3 months. If I over medicate I end up with 10 per day.

Title: Re: rebounds?
Post by nancyc on Mar 17^th, 2002, 9:54am

Elissa, I know about the procedure you are talking about..I am an RN that works in a drug rehab center...email me and I will be glad to talk to you about that although it has proved not to be very effective. You can get thru the withdrawals this way but there are alot of drawbacks.. :)