Taken Alot of triptans 4 to 5 injections a day and have just found out about re-bound CH. please can someone tell me what these are and any tips. im 43 years old suffered from CH for 14 years only diagnosed in the last 2. Doc has also only just put me on verapamil.

Any help....Cheers Guys and Girls

It's actually a point of conversation from time to time, and an important one, I think. A rebound HA is a new hit which comes as a result of the meds taken. Think of nasal spray. As your nose becomes symptomatic, you inject your favorite spray up your nostril. Then relief and you can breathe again, for a couple of hours maybe. Then your nose once again becomes symptomatic, and you spray again. This time it only works for one hour. You repeat and find the rebound effect comes more quickly the more you use the med for relief. It stops when you stop shooting spray up your nose but it's very stuffy for a bit as your tissues readjust. Some feel this happens with triptans and CHs.

A recurrent HA is a brand new hit coming on the heels of the previous hit. In vicious cycle, or as a high cycle chronic, I have found these can come as quickly as 15 minutes. So you get hit with a string of recurrent HA's over a period of hours. Treatment for a recurrent HA string is the same as aborting a single hit. Stopping the abortive won't stop the hit.

Hope this helps. Blessings. lance

We tend to use "rebound" a bit too robustly here AND, in the closed context of our chats, it can take on a meaning which is not always consistent with the medical usage/meaning of the word.
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Rebound headaches. "Rebound Headaches--A Review", Au. John S. Warner, M.D., in HEADACHE QUARTERLY, 10:3(1999). (There is some confusion on the board about the meaning of "rebound". There appears to be an emerging consensus in the medical literature to define "rebound" as a headache which is caused by the overuse of any medication used to abort a headache or relieve pain. "Recurrence" [of a headache] is being used to refer to the redevelopment of an attack when its "normal" duration is longer than the useful life of the medication which has been taken. That is, the medication effectiveness is reducing before the headache has come to an end; the pain redevelops.)
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Sumatriptan has a hard initial punch and relatively short effective life--a combination which works well for most Cluster attacks. However, some people, whose Clusters have a longer life, find that the med is wearing down even as the pain continues. One can understand how this sequence comes into one's thinking: Attack, Imitrex injection, pain continues, it's a rebound cluster which has developed from the Imitrex. In fact, this is a recurrence of the attack, not a rebound.

This is one of the reasons that several other triptans were developed having less initial punch but longer effective life. While aimed at the migraine crowd, at first, a number of cluster users have found this characteristic of value to them.
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For rebound headaches, or when they are suspected as coming from an abortive you are using, the only test is to stop using that med. If the frequency of attacks reduces, the assumption that this med has been the problem. Then you change abortives.

What Bob said! :)

There are people on this board who SWEAR Imitrex extends cycles and causes rebound headaches...but we lack any clinical trials that really show this. If you can get oxygen, try it for a few weeks as your abortive, it works just as fast and effectively for me as the trex does, without that imitrex hangover feeling. If your hits drop in frequency and intensity, maybe the trex is causing rebounds...or maybe your cycle is winding down! ::)..............yeah, the joys of establishing cause and effect with beasty!

Joe

Imitrex injections have always been great (for me) to stop an attack. My pain goes completely away ... then I get another attack later and repeat this cycle. I have found in the many years that I've used Imitrex that the more I use, the more I HAVE TO use. I do try my best to avoid it unless I feel it's absolutely neccessary. I do my best to prevent the attacks and the need for Imitrex in the first place ... cause it always sucks if I 'have to' use Imitrex.  :-/    (yet, I still will NEVER leave home without an Imitrex injection (or 3) !

Headache. 2004 Jul;44(7):713-8.   

 
Subcutaneous sumatriptan induces changes in frequency pattern in cluster headache patients.

Rossi P, Lorenzo GD, Formisano R, Buzzi MG.

Objectives.-To document the relationship between the use of subcutaneous (SQ) sumatriptan (sum) and a change in frequency pattern of cluster headache (CH) in six patients. To discuss the clinical and pathophysiological implications of this observation in the context of available literature. Background.-Treatment with SQ sum may cause an increase in attack frequency of CH but data from literature are scant and controversial. Methods.-Six CH sum-naive patients (three episodic and three chronic according to the International Headache Society (IHS) criteria) are described. Results.-All six patients had very fast relief from pain and accompanying symptoms from the drug but they developed an increase in attack frequency soon after using SQ sum. IN ALL PATIENTS, THE CH RETURNED TO ITS USUAL FREQUENCY WITHIN A FEW DAYS AFTER SQ SUM WAS WITHDRAWN OR REPLACED WITH OTHER DRUGS. Five patients were not taking any prophylactic treatment and SQ sum was the only drug prescribed to treat their headache.

CONCLUSIONS.-PHYSICIANS SHOULD RECOGNIZE THE POSSIBILITY THAT TREATMENT OF CH WITH SQ SUM MAY BE ASSOCIATED WITH AN INCREASED FREQUENCY OF HEADACHE ATTACKS.

PMID: 15209695 [PubMed]

{Note from BJ: Review of PubMed in 1/11 found no citations with this type of data in the last 10-years. The absence of newer reports suggests that experience of recent date is not stimulating much attention on this topic. In view of this reports comments about quick return to the former headache pattern, it appears such changes in frequency is not a significant issue.}

A full 6mg injection will abort an attack for me in less than 30 seconds.

Using the Imitrex Tip, a 3mg injection will abort an attack within 3 minutes flat.

I've personally found that the more trex I use, the more frequent the attacks.

"Damned if you do, damned if you don't!"

When available, high flow O2 is the best choice to abort!

I found early on that Trex causes rebounds for me. I ended up getting a needle free injector and I get my Trex in vial form.  I use 1/3rd of the dose and it does the same job without a rebound. 

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Triptans increase human growth hormone. 

Somatostatin is also known as "growth hormone-inhibiting hormone" AND for clusters it has been found that "Infusion of somatostatin reduced the maximal pain intensity and the duration of pain significantly compared to placebo treatment, and to a degree comparable to ergotamine tartrate treatment"

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All this makes me wonder if this correlation is responsible for why so many people feel like the triptans keep you in a spiral of pain.  The triptans are actually increasing a substance that seems like when reduced will actually GET RID of your cluster.   Coincidence?

I don't mind rebounds.  I abort them too.   ;D

I for one has no doubt whatsoever about the rebound effect. The Imitrex salavation has its price. Reducing the frequency and amount of injections do help.

Zeitgeist wrote on Nov 22^nd, 2011 at 5:10am:

Reducing the frequency and amount of injections do help.

I agree.  Now that I have switched my 1st course of action to Ketamine I have noticed that I am not dealing with NEARLY as many headaches.  And it seems like I can take a triptan every once in a while and not suffer rebounds too bad (and I make sure I treat what I think of rebounds with ketamine, not more triptans)  Either the ketamine is having a good long term effect on the clusters (Not impossible) or I'm finally not dealing with rebounds, just the real headaches.

Ricardo wrote on Nov 22^nd, 2011 at 10:29am:

Zeitgeist wrote on Nov 22nd, 2011 at 5:10am: Reducing the frequency and amount of injections do help. I agree.  Now that I have switched my 1st course of action to Ketamine I have noticed that I am not dealing with NEARLY as many headaches.  And it seems like I can take a triptan every once in a while and not suffer rebounds too bad (and I make sure I treat what I think of rebounds with ketamine, not more triptans)  Either the ketamine is having a good long term effect on the clusters (Not impossible) or I'm finally not dealing with rebounds, just the real headaches.

  What is the dosage and what brand?

            Potter

It's intranasal ketamine spray, 25 mg/ml.  It is not actually manufactured by any company, so it has to be compounded.  At this point this is such a new therapy that the dosage has not been really figured out yet.  When I sent a message to my Neuro about how 1-3 sprays hardly does anything he told me he has been "drastically under dosing" and he expects to at least double that to 50 mg/ml when I see him on the 30th.

-Ricardo