Has anyone had any luck with using a fentanyl lollipop for the initial night attack followed by zomig and O2?

Bryan wrote on May 3^rd, 2010 at 9:39pm:

Has anyone had any luck with using a fentanyl lollipop for the initial night attack followed by zomig and O2?

     No.

        Potter

I use just oxygen.....with a Red Bull kicker to ward off secondary attacks. When 02 has failed me......which has really been rare...I go to the imitrex stat pen.

Absent some other condition, narcotics are rarely useful in the treatment of CH. Their down sides far outweigh their benefits. Do you currently have a useful prevent medication you're using? Lithium, Verapamil, Topomax etc.? I use lithium, it has drmatically decreased the need for my abortives.

Joe

Since this is your first post, you have not been, I assume, reading just how often we write in opposition to the use of narcotics to treat CH. It has only one appropriate use--when all other meds have failed.

If a doc has given Fentanyl to you I should seriously question his knowledge/experience (unless you will provide a full history of your CH experience which might modify my judgment.)

We now have a range of safe, effective meds which, when used in appropriate combinations/doses give a high rate of success in controlling CH. I'd encourage you to read two articles which introduce standard treatments for CH.
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Cluster headache.
From: START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE (Orphanet Journal of Rare Diseases)
[Easy to read; one of the better overview articles I've seen. Suggest printing the full length article--link, line above--if you are serious about keeping a good medical library on the subject.]

Leroux E, Ducros A.

ABSTRACT: Cluster headache (CH) is a primary headache disease characterized by recurrent short-lasting attacks (15 to 180 minutes) of excruciating unilateral periorbital pain accompanied by ipsilateral autonomic signs (lacrimation, nasal congestion, ptosis, miosis, lid edema, redness of the eye). It affects young adults, predominantly males. Prevalence is estimated at 0.5-1.0/1,000. CH has a circannual and circadian periodicity, attacks being clustered (hence the name) in bouts that can occur during specific months of the year. ALCOHOL IS THE ONLY DIETARY TRIGGER OF CH, STRONG ODORS (MAINLY SOLVENTS AND CIGARETTE SMOKE) AND NAPPING MAY ALSO TRIGGER CH ATTACKS. During bouts, attacks may happen at precise hours, especially during the night. During the attacks, patients tend to be restless. CH may be episodic or chronic, depending on the presence of remission periods. CH IS ASSOCIATED WITH TRIGEMINOVASCULAR ACTIVATION AND NEUROENDOCRINE AND VEGETATIVE DISTURBANCES, HOWEVER, THE PRECISE CAUSATIVE MECHANISMS REMAIN UNKNOWN. Involvement of the hypothalamus (a structure regulating endocrine function and sleep-wake rhythms) has been confirmed, explaining, at least in part, the cyclic aspects of CH. The disease is familial in about 10% of cases. Genetic factors play a role in CH susceptibility, and a causative role has been suggested for the hypocretin receptor gene. Diagnosis is clinical. Differential diagnoses include other primary headache diseases such as migraine, paroxysmal hemicrania and SUNCT syndrome. At present, there is no curative treatment. There are efficient treatments to shorten the painful attacks (acute treatments) and to reduce the number of daily attacks (prophylactic treatments). Acute treatment is based on subcutaneous administration of sumatriptan and high-flow oxygen. Verapamil, lithium, methysergide, prednisone, greater occipital nerve blocks and topiramate may be used for prophylaxis. In refractory cases, deep-brain stimulation of the hypothalamus and greater occipital nerve stimulators have been tried in experimental settings.THE DISEASE COURSE OVER A LIFETIME IS UNPREDICTABLE. Some patients have only one period of attacks, while in others the disease evolves from episodic to chronic form.

PMID: 18651939 [PubMed]
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and the PDF file, below.

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I'm just going to copy and paste this every time I see an opiate thread.

Opiates = no cluster relief, just addiction

Sure, it will take the pain away and it will turn you into
mush in time when you need it more and more and yet even more and before you know it, you're in rehab.

Read the following post:

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

Quote:

Sure, it will take the pain away...

Most of the time it doesn't even do that.

We've had at least one member here (that I know of) who died from an accidental overdose of fentanyl.  A patch, yes, but the same drug.   

Best,

George

Bryan, to sum up your question, just stick with the zomig and O2.  Bottom line, if your doc prescribed Fentanyl, he/she knows nothing about cluster headache then.

Proper O2 use for CH MUST be with a NON-rebreather mask with a bag on it and a regulator that goes to at least 15lpm.

A rebreather mask has no bag and the nasal canula are NOT good CH tools. Just in case you don't know this.

Morphine will not stop a CH for me, just made me tired and still in pain.

Don

I have tried Verapamil, up 720mg, and am now on Topamax. After the first night attack is over, I can control them with the Zomig/O2. The first attack nothing seems to help. I have heard of drinking excessive amounts of water or vigorous excercise. But that is not possible while in the first attack because of the severity of the pain. Any other suggestions?

With O2 you MUST use it at the 1st hint of pain, waiting will delay and sometimes cause a failure to abort. Proper use of O2 is important, you must get 100% pure O2, no outside air, period.

If you haven't, please read the "oxygen info" tab to the left. The more info you have the better for treating your CH.

Good Luck, Don

Have you tried melatonin for night hits??

Could you tell me what dosage on the Melatonin. I take between 3-5mg just to help me sleep...

USMCWIFE wrote on Mar 29^th, 2011 at 7:56pm:

Could you tell me what dosage on the Melatonin. I take between 3-5mg just to help me sleep...

Rozen is suggesting we can go upwards of 24mg to use as a preventative.
My magic numer was 9-12mg

Thank you E. Love the Captain Kangaroo pic. *sigh* being a kid was so much easier!!!

USMCWIFE wrote on Mar 29^th, 2011 at 7:56pm:

Could you tell me what dosage on the Melatonin. I take between 3-5mg just to help me sleep...

If you're taking melatonin just to help you sleep, 1/2 mg. will work better than 3-5mg.  I know, sounds wrong, but it's well documented.

For C-H, about 10mg seems to work best for most - that's what I use in my preventive mix, and I'm pf for about 4 years now.

GL & Best regards,
Jim

Opiates are horrible drugs that can very easily lead to a horrible path of pain and addiction.  And many times they have helped my clusters greatly.  I'm so amazed at how often everyone says "Clusters are an individual thing, what works for one person won't work for the next" But as soon as narcotics are mentioned, it's "No way you're just going to be a junkie and it's not going to help you at all"  I think it should be an absolute last option...ESPECIALLY if it's Fentanyl...But I've had too many times in the ER where they shoot me up with Trex and it takes it down a notch, but it's still there.  After that, I've had dilaudid, morphine, and demerol work, and surprisingly they seemed to have fewer rebounds than I seem to get from Trex.  I think busting is the way to go, Oxygen is the way to go, try the vit D and fish oil, maybe get your testosterone checked, maybe try the licorice trick...I have to admit the idea of a fentanyl lollipop at night sounds scary, Your Doc isn't saying EVERY night is he?  THAT would be bad.  Another thought....Have you even taken the opiates and tried to sleep yet?  A lot of people (including me) find they'll nod off on the couch only to find they're staring at the ceiling awake when it comes time for actual sleep.  Another thought---Have you tried zyprexa?  I've heard it mentioned here by a couple people.  Haven't tried it, I'm going to ask my Neuro for a script when I see him on Mon.  The reason I ask is because it's a tweaked out benzodiazepine (family that valium is in) that is supposed to work well for aborting CH.  If it gets rid of the pain it would probably help you sleep...Last thought---Use the opiates as a LAST LAST LAST resort, Always ask yourself if there is ANYTHING else that will help and always try those options until there is nothing else.  When I get to that point, I take opiates...Seems like it does better things for my brain then getting hit.  AND BE CAREFUL!   Wow, I really hope I haven't ticked anybody off...Just my 2 cents :-?