I would appreciate some feedback on Imitrex spray.

Currently on prednisone and gabapentin.  Also just prescribed O2.  O2 is a miracle!

My main question is, can I count on the spray as an abortive when I'm away from O2?  I can't see me carrying a tank everywhere I go.  I know many here use injections, but I hate needles, and I'm not that desperate yet.

Second question.  If the spray does help, and your nose is blocked on the side with pain, does it work if sprayed in the other nostril?

Thanks for any comments, you have all been a big help!

Todd

I can address one of those. The actual drug is absorbed into the bloodstream via the nasal membranes, then acts to constrict your blood vessels. It doesn't matter if your sinuses are blocked on the side of the pain. That's not now the drug works (as in direct contact with something in your head).

The spray gets quite mixed reviews here. Another option is a pill which is less expensive per dose and highly effective for a number of us. Your doc can give you a sample and you will know within 1 or 2 tries if it works for you.
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Headache 2001 Sep;41(8):813-6  

Olanzapine as an Abortive Agent for Cluster Headache.

Rozen TD.

Department of Neurology, Jefferson Headache Center/Thomas Jefferson University Hospital, Philadelphia, Pa.

OBJECTIVE: To evaluate olanzapine as a cluster headache abortive agent in an open-label trial. BACKGROUND: Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs. METHODS: Olanzapine was given as an abortive agent to five patients with cluster headache in an open-label trial. THE INITIAL OLANZAPINE DOSE WAS 5 MG, AND THE DOSE WAS INCREASED TO 10 MG IF THERE WAS NO PAIN RELIEF. THE DOSAGE WAS DECREASED TO 2.5 MG IF THE 5-MG DOSE WAS EFFECTIVE BUT CAUSED ADVERSE EFFECTS. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose. RESULTS: Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and two patients became headache-free after taking the drug. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness. CONCLUSIONS: Olanzapine appears to be a good abortive agent for cluster headache. IT ALLEVIATES PAIN QUICKLY AND HAS A CONSISTENT RESPONSE ACROSS MULTIPLE TREATED ATTACKS. IT APPEARS TO WORK IN BOTH EPISODIC AND CHRONIC CLUSTER HEADACHE.



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Olanzapine has a brand name of "Zyprexa" and is a antipsychotic. Don't be put off by this primary usage. Several of the drugs used to treat CH are cross over applications, that is, drugs approved by the FDA for one purpose which are found to be effective with unrelated conditions--BJ.

Hi Todd,

Like you, I don't like needles.  This was keeping me from using the injectible Imitrex, I always carried.  Ever since I had (what was for me) an atypical CH cycle occur in April 2006 (up to that time, I'd never had CH in the Spring), and my neuro found out I was not using my Imitrex, I have been using  nasal spray form abortives. I typically use Migranol (it works fine for me, but not necessarily for everyone).  During one cycle (in Feb. 2007), I did use Imitrex in nasal spray form.  It worked OK (but I preferred Migranal, so I went back to that).  Nasal spray abortives will stop CH attacks, but realize that they do take longer to work.  Unlike O2 (which can work within say 2 to 5 minutes in many cases), and Imitrex injections (which can have an effect within a couple of minutes), you may find that while you may start to feel relief in 5 or 10 minutes, it can often take 20 minutes before the CH really goes away.

Hope you all had an enjoyable PF holiday and thanks for the feedback on sprays.  I will speak to the Dr. about adding it to my arsenal.  

I have used the 20mg nasal spray nearly exclusively over the past 10 years and I find it very effective.

It usually will abort an attack in about 13-15 minutes for me (after enough attacks I count the seconds!).

I never have had problems with blocked nasal passage and the imitrex working.  My biggest problem is breathing in too fast and hard and it not staying in the nasal passageway.

Consider Zomig nasal spray...it is my last line of defense when the O2 doesn't work..has only failed once in 5 years. No personal experience to relate re Imitrex NS, but my take on the combined experiences here is that it is superior...YMMV!

Best,

Jon

My neurologist recommends that I use my nasal spray on my left nostril (my CH is on my right side) to ensure that a blocked nostril causes reduced absorption. As other people mentioned, you do not have to use it on the side of the pain since it's action is systemic.

I have had very good results with Imigran nasal spray. Especially when I was on prednisolone at the same time. The longer it ever took to abort was 15 minutes but I can feel less pain after about 5.

I have used imitrex nasal spray for years for ch and migraine.  I have used 20mg and 10 mg nasal spray in either nostil and it works in 6-10 min for me.  Just as fast as a shot and I hate needles also.

I use the nasal imitrex as a back up since my ins co. only allows me so many shots per month.  I have found that it does work but usually takes twice as long as a shot to work.  The shot generally works for me with in 10 min.  Nasal generally takes at least 20 min.   It does matter if your nasal cavity is already blocked so try to use it before you get to the blockage point.  If you miss it use the other nasal cavity to inject spray.

The Nasal works better if you can get it / use it at the 1st twinges of an attack, if you wait too long you may wind up pacing and rocking anyway.