I've noticed that when I'm in the worst part of a CH cycle and getting 2-3 CHs each night, when I take Immitrex or Zomig during my first attack of the night, I won't get any subsequent CHs that night.   Any thoughts on just taking a dose as a preventative before bed?

Historically speaking, triptan's are abortives. Myself I can only speak on my 28 years of experience with CH both episodic and chronic.

If you are in the early part of your cycle then you will experience many more attacks a day when you start to peak. Generally, abortives such as sumatriptan will abort your attacks but more than usually will also bring you worse headaches the more you abort. Again, every sufferer is unique as to what works and how many attacks a day they receive. I would strongly urge you to try and use the sumatriptan as little as possible and talk to your doctor about getting on oxygen as an abortive, It's 10x safer to use than sumatriptan.

Are you currently using a preventative?

Adamt - My experience has been similar regarding using sumatriptans and getting more severe CHs.  I'm just pretty desperate to get some sleep.  I need to try oxygen again but I can't get in to see my Neuro for another week. Last time I tried, it didn't work but that was years ago and the flow could have been too slow.  I've had these suckers for 35 years now.  They started chronic and moved to episodic.  My episodes seem to be getting farther and farther apart (years between outbreaks now) but the CHs are definitely more severe.

Seaworthy - I just tried a Methylprednisolone that did nothing.  I've tried several others with no help (lithium, verap, topamax).  I'm thinking of giving verapamil another try.

One drug trial using sumatriptan as a preventive concluded that it was not helpful.

I suspect  this related to the relative short half-life of tripans when we need hours long benefit.

Assume you have seen the protocol on use of Verapamil. It's clear, this is first choice as a preventive, but correct dosage is essential.

Just got a script faxed for the O2 and just got off the phone with the supplier.  I may actually have it at the house in time for this evening's ride.  Definitely going to discuss the verap when I finally get back in with my Neuro

There is a string from a couple of months ago which discussed taking a pill just before bed.  Not sure who started the string - but the theory was that many attacks start during REM sleep, that the 1/2 life of Imetrix is about 2 1/2 hours and that it takes time for the oral dose to get into the blood stream, so if you took a pill right before bed it could be timed properly to "treat" or abort the hit.

Sounded good to me, I had the pills and this was the first cycle where I was getting hit at nights during the peak, so I tried it.  For whatever its worth - I did not have any more night hits this cycle (which is now over) while doing that.

Bear in mind though - I have convinced myself (by looking at a few studies on the topic) that the instruction to not use more than two injections (or combinations of injections and pills) within a 24 hour period is bunk.  I have used up to 4 injections in 24 hours and didn't feel any different, and they were just as effective.  If you feel the need to follow the prescription warning then I would advise not to waste the chance for a shot to abort because you took a pill right before bed.

Just my opinion. Good luck.

23 yrs experience, never had anyone (patients, doctors, neuros, etc) even suggest Triptans could be used as a preventative. It just doesn't work that way and is too dangerous. The less you take, the better. And REM sleep is unavoidable.

I4B

Still think the theory is a good one - and I take it (regardless of what your handle imply's) you are fearfull of long term triptan effects?  Have you not seen the few studies regarding dosage and long term effects?  Compared to many a drug out there, Imetrix seems pretty harmless based on those. 

I can find em again if you want?

Don't let my username fool you. I use Imitrex ONLY when absolutely neccessary. I use DHE IM injections as a prevent and rarely Imitrex anymore. It seems the more Imitrex I use, the more I HAVE TO use.

I4B

Haven't been back on this site since I got the O2.  Freakin amazing.  I wake up 1-3 times a night, take the O2 for 5-10 minutes and the CH is gone and I'm back asleep in no time.  Even on my worse nights I only miss about 45 minutes of sleep.  Haven't need the Zomig or immitrex once since getting the O2.  I can't beleive I've been suffering through these things and spending a fortune on drugs for over 30 years and a tank of O2 is all it takes.   AMAZING

Great to hear that oxygen is transforming how you deal with CH. You can now understand why people here tell people to get it.

Freddy,

If you don't have one already, go to the ch.com store on the left in yellow and order an O2ptimask.  They are amazing!  Much more comfortable than the ones the O2 suppliers give you, they have a bigger bag, and the mask fits so much better with a valve that actually works at expelling your breath and blocking outside air.  It is well worth the $30 bucks or so they cost.

Jerry

My husband has taken Frova at bedtime which is along the lines of Immitrex and it 85% gets him completely through the night without ever getting awakened by an attack!  Great help to him during the early to mid stage of a cluster episode.

I have used Relpax 40mg for a nighttime prevent, has a longer half-life. I love the O2 but only get 30-60 minutes of sleep at a time, have insomnia and usually can't even get to sleep before I get hit. This gave me the sleep... 6 hrs. wow!
BUT... WARNING... I do not use it anymore after determining that it was likely causing some rather nasty rebound effects. If I do reach for it because the sleep deprivation is killing me, I will only use it once every 3 or 4 days max!
If the O2 is aborting quickly and you are loosing only 45 minutes a night... in my book you are golden with the O2 only.
(HOLY SH@T... 30+ years without Oxygen? Good thing they don't come that often!)

Good to hear that the O2 is helping you. That is great news!

I only have 1 more comment and that is that telling anyone that "No more than 12mg of Imitrex (or 2 [6mg] injections) per a 24 hour period" is "Bunk" could spell disaster for another person that takes that advice and overuses Imitrex or other Triptans. They would most likely be alright, but then again, it could KILL them. Everyone should use Triptans (and other meds) carefully.

Just my opinion,   8-)

I4B