Hi all, I have been a survivor for 25 years and am in a 2 week cycle after a 3 year remission. I have been reading this board since inception and without it and this community,  I don't know where I would be today. I am thankful for all the information and support I have found here over the years.
I am 49, female and relatively healthy. Currently on 480mg verapamil, imitrex injections and 02 to abort. I have tried numerous cocktails over the years, but this is typically what works the most consistently for me. I adjust verapamil during cycle and taper off after conclusion. Was on a 5 year daily dose of 120mg as preventative, but was off for the past year as it was third year of remission. Hopefully near end of cycle. Have overdone imitrex in the past when having 5-6 attacks in a 24hr run. I haven't in years as 02 works most of the time and use it more than trex. Only for days that I am not home or those monsters in the night. Yesterday after waking up to a 8kip used an 4mg injection and had heart palpitations for about 30 minutes. Same thing early this morning. Never happened before. I hesitate to talk to neurologist as we all know he will tell me to stop imitrex, don't know if I can go there. Any thoughts or suggestions would be helpful.

Hey KZ,

Welcome to CH.com.  You've come to the right place with your post.

I know what you're going through and the heart palpitations are scary.  Check your PM inbox.  I've sent some suggestions.

Hiding problems like this from your doctor isn't a good idea even though you already know what he's going to say and know it's the smart thing to do.

When you see him or call, beat him to the punch, tell him you're cutting back on the imitrex and ask for a lab test of your 25(OH)D.  You're likely vitamin D3 deficient and that deficiency is contributing to the frequency, severity and duration of your CH. 

That deficiency also has you in a downward spiral of medication-induced headaches taking far too much sumatriptan succinate that's only going to get worse without a change in treatment... and the sooner the better.

When your 25(OH)D labs come back indicating a vitamin D3 deficiency...  a 25(OH)D serum concentration less than 30 ng/mL... and they will...  I've got a coke & candy bar riding on that bet... take a look at the following link:

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

Take care and please keep us posted.

V/R, Batch

Hiding from your doctor is never good form! This is especially unfortunate when what you are withholding is not an important medical issue.

When Imitrex was firs introduced, there was a flurry of reports about chest tightness & pressure which aroused concerns. After experience in broad use, the conclusion was that this wasd NOT a sign of heart disorder and that concern largely disappear in the literature.

More refined experience developed with time so that there as a recommendation: be screen for existing heart disorders and, probably, don't use it if there is heart related history.

Today, there is advise across the spectrum: use only at recommended dosing; safe to use at much above recommended dosing (again, in the absence of any history of heart problems). Following abstract is, from what I see, a reasonable, mid-road posture:

Expert Opin Pharmacother. 2010 Nov;11(16):2727-37.
Sumatriptan therapy for headache and acute myocardial infarction.
Barra S, Lanero S, Madrid A, Materazzi C, Vitagliano G, Ames PR, Gaeta G.

SourceAntonio Cardarelli Hospital, Cardiology Unit, Via Antonio Cardarelli, 9, 80131 Naples, Italy. giovanni.gaeta@tin.it

Abstract
IMPORTANCE OF THE FIELD: Migraine is a common, debilitating, chronic neurovascular disorder. Triptans are considered the drugs of choice to treat migraine attacks; however, their use is limited owing to concerns about cardiovascular safety.

AREAS COVERED IN THIS REVIEW: The aim of this review is to describe: the mechanisms of action of triptans; the case-reports of acute myocardial infarction (AMI) associated with sumatriptan use; and the results of studies evaluating its tolerability and safety.

WHAT THE READER WILL GAIN: Sumatriptan administration can be followed, in close temporal relationship, by AMI in young or adult migraine patients. Some of these cases have developed in subjects taking their first dose. Based on the results of prospective studies,

THE RISK OF SEVERE CARDIOVASCULAR ADVERSE EVENTS AFTER THE USE OF A TRIPTAN IS ESTIMATED AT 1:100,000 TREATED ATTACKS. THESE ADVERSE EVENTS, ALBEIT VERY INFREQUENT, HIGHLIGHT THE IMPORTANCE OF CAREFUL ADHERENCE TO THE SUMATRIPTAN PRESCRIBING INFORMATION.

TAKE HOME MESSAGE: Inherent in its mechanism of action, sumatriptan could produce (coronary) vasospasm sometimes followed by AMI. The drug should not be prescribed to patients with history, symptoms or signs of ischemic vascular disease; an in-depth evaluation should be carried out in subjects at intermediate cardiovascular risk.

PMID:20977405[PubMed]
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If you are not comforted by this information, print the PDF below, and talk with your docabout doing a trial. When I tried the firs time, it became my only abortive. Works almost as fast and Imitrex injection, vastly cheaper on a per dose basis. Limited only if you need multiple doses per day.
----
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.

PMID 11576207 PubMed

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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.
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Since this abstract was first posted Zyprexa has appeared in some lists of recommended meds for CH. [BJ]

Do talk to your doctor about this. Whilst you may be worried that you'll have to stop using Imitrex it is possible that there is a heart issue that needs to be investigated.

Don't ignore warning signs to do with your heart.

Thank you all for the information and links. I obviously have some more reading to do. The good news is that I recently had some tests run (unrelated to CH) and my heart is in great condition. I was more curious as to why after all these years I suddenly have the palpitations from trex as I have never experienced in the past. I will of course talk to my neurologist as we have had a long standing relationship, but I know his immediate response will be to stop and err on the side of caution. I am looking for any others that have experienced the same and try to load up on knowledge.
In the meantime I have received some wonderful new tools from this awesome community that was unexpected and is greatly appreciated.  :)

Good to hear that you've had your heart checked out and it is fine.

The first time I tried using Maxalt Melts which is another triptran, I got heart palpitations which were significant enough to get me a trip to hospital. Since then I've used the same medication multiple times for migraines (I get them too) with zero issues.

So it could just be a one off.

Hi KZ

Much like you, I would be reluctant to talk to my neurologist if I thought he would take me off trex, but if your symptoms recur it would probably be best to do so, notwithstanding the good report on the condition of your heart.  If this happens, be sure to go over the possibility that verapamil may be contributing to the problem.  Irregular heartbeat is a known complication of verapamil especially at higher doses like the 480 mg level you are taking.  If varapamil isn't stopping the cluster, I'd want to hear some persuasive reasons why the doc wants to stop trex rather than stopping verapamil.

Best of luck and PF wishes to you!

Hi,

I'm on Imitrex/Imigran (oral) and also sometimes use Cafergot (due to it being cheaper, huge price difference). My neurologist knows I switch between the above meds during alternate cluster attacks on different days to manage my episodes and by budget. Question - has anyone ever tried to manage the heart palpitations after consuming the Imitrex or Cafergot (Ergotamine and Caffeine) using any techniques?

E.g. Would drinking lotsa water (post meds consumption) or other take other meds to control heart palpitations? Would like to hear from someone who has experience heart palpitations using the above meds and perhaps managed to find a way to manage this.

I read that oxygen (inhaling) helps the heart when cuz the heart doesn't have to work harder - so maybe there is causal link with regards to managing palpitations.

Many thanks. :)