Anybody ever use one for clusters?

I used to use the oral cafergot in combo with my oxygen. I know some used to use the suppositories. hadn't heard of an inhaler version!

Joe

There's a delivery method for dihydroergotamine-45 where you sniff it up into your nasal cavity. It's called Migranal.

I used the cafergot inhaler many years ago.  Worked well BUT was never sure how much medicine was inside and would run out unexpectedly.  Guess it would be ok if they started you out with two inhalers so you always had a backup.

Addition:  Works well as far as cafergot goes.  Not as fast to work as O2 or the triptan drugs.

It was my treatment for several years. The supply became so unstable (being displaced by better abortives which were coming on the market) that I haven't asked if it's even available now.

If available, it would not be high on my list anymore because, even when used with the best technique, it's effectiveness was only so-so.

I have both, the DHE-45 Migranal nasal spray and the trex injectables. Migranal does work for me (not terribly fast, but reliably) and can put off the hits for about 48 hours after taking it. It is more "public use friendly" than imitrex. Nobody blinks when I take out a vial, prepare it and use it. They just think it's nose spray. The last time I checked the survey results on the left not many had good experiences with it, but I have. We're all different. I'd say it's worth a try if your doc wants to go that route. I also responded well to DHE-45 IV when brought to the emergency room with a 4 hour KIP 10 a couple of years ago. Hope it works for you. Blessings. lance

We are now talking about two different products. "Ergomar" inhaler is not DHE-45.

Some of these "kids" are too young to know what the good old days were like!

Ding ding ding! We have a winner!

That's the first time I've been called a "kid" since I turned 50 a couple of months ago.

Thank you, Bob.

Think I'm going to ask my Doc about both of them! Have people had better luck with one versus the other?

Some of these "kids" are too young to know what the good old days were like

Yeah, when the best they had to offer us was cafergot oral or suppositories....cutting edge technology! ;D

If you have the option the imitrex injectables ar the fastest abort I've ever used. Oxygen is a close second.

Joe

Just so you know, Imitrex (sumatriptan) is also available in snort form.

Since you appear to be the "new kid on the block", let me suggest:

1. PDF file, below.
2. START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

Here is a link to read and print and take to your doctor.  It describes preventive, transitional, abortive and surgical treatments for CH. Written by one of the better headache docs in the U.S.  (2002)
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Michigan Headache & Neurological Institute for another list of treatments and other articles:

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

3. And, a good overall introduction to CH, including treatments:

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE
This outfit offers a number of titles, each covering a separate medical condition.  Good, Written in non-technical language. Broad coverage of CH--causes, treatments, etc. Worth exploring the sample pages.
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MANAGEMENT OF HEADACHE AND HEADACHE MEDICATIONS, 2nd ed. Lawrence D. Robbins, M.D.; pub. by Springer. $50 at Amazon.Com.  It covers all types of headache and is primarily focused on medications. While the two chapters on CH total 42-pages, the actual relevant material is longer because of multiple references to material in chapters on migraine, reflecting the overlap in drugs used to treat. I'd suggest reading the chapters on migraine for three reasons: he makes references to CH & medications which are not in the index; there are "clinical pearls" about how to approach the treatment of headache; and, you gain better perspective on the nature of headache, in general, and the complexities of treatment (which need to be considered when we create expectations about what is possible). Finally, women will appreciate & benefit from his running information on hormones/menstrual cycles as they affect headache. Chapter on headache following head trauma, also. Obviously, I'm impressed with Robbins' work (even if the book needs the touch of a good editor!) (Somewhat longer review/content statement at 3/22/00, "Good book....")


HEADACHE HELP, Revised edition, 2000; Lawrence Robbins, M.D., Houghton Mifflin, $15. Written for a nonprofessional audience, it contains almost all the material in the preceding volume but it's much easier reading. Highly recommended.

[MEDIFOCUS title is newest and easy to read.]
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Ergotamine products are one of the least effective abortives available today. At one time, a mainstay, but not where to begin treatment today.

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I've had every type of triptan know to man, snorts, shots, under the tongue....My real issue is that I don't want to take any more triptans!   I'll take them if I have no other option, but seems like the more I take, the more headaches I get.  Even then, I feel like they are great when I need them, but they just send me into a triptan spiral, causing rebounds after rebounds until I blow my mind open with hallucinogens.  I'm young enough that I have not tried any ergot meds and wonder if they will give the same sort of rebounds.  I know many people feel that they are not as effective, but if they didn't have the same rebound effect I think they might be worth it. 
BTW---I live in the Northeast of the good ole USA, why?
Another BTW---I'm a newbie to the board, but not to the clusters...  Been dealing with them for the past 12 years, at least 6-7 of them chronic.  Done a lot of research through the years....Only thing that has given me non-rebound relief is hallucinogens...

Ricardo wrote on Feb 26^th, 2011 at 12:59pm:

My real issue is that I don't want to take any more triptans!

You've not mentioned using oxygen to abort CHs. Have you tried it with a non-rebreather mask at a high flow rate?

Tried oxygen a bunch of times, never worked.  Only convinced I got it the right way once in the ER, but I was at about the worst I've ever been...Seemed like it at least stopped me from passing out (although that might have been a blessing) but the little help it seemed to do stopped as soon as the O2 was done.  (Not convinced that it wasn't placebo)  On the other hand, I was reading on the board someone saying that O2 only helped their NIGHT time headaches, which I have not tried...Figure I might as well ask the doc to try again!

We always ask what area people live in as it tells us how available different treatments are. oxygen is almost impossible to get in the UK but relatively easy here. Melatonin is OTC in the states, but prescription only in Europe! So it helps us help you a bit more.

If you haven't tried the 02 route, do give it a look. Most of our "clusterbusters" sisters and brothers use the 02 as an abort as it's one of the few things they can use while they detox before starting the Clusterbuster routine.

Joe

Ah!, Ricardo: Ask the right question and get the right answer.

Alternative to triptans--something which has worked very well for several of us here:

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.

Wow Bob---You're the man!  An abortive that can work within 20 min?  You can even mix it with triptans if it doesn't work!  Looks like it's cheap too!  This seems like one of the less scary anti-psychotics as it is, some bad side effects like weight gain and blood sugar problems, but looks like those are mostly problems for people taking it everyday.  Definitely gonna do some more research into it and ask the doc.... :)

Ricardo wrote on Feb 26^th, 2011 at 1:50pm:

An abortive that can work within 20 min?  You can even mix it with triptans if it doesn't work!  Looks like it's cheap too!

Sounds like oxygen to me, although 20 minutes is a very, very long abort time.

Ricardo, I was typing too quickly and neglected to mention:

The abstract covered a few people. Since then, this med has started to appear in lists of recommended treaments for CH, i.e., the experience is consistent with this brief report.

IF it works for you, there are no reports of the headache redeveloping after a time. My personal experience: headache cleared with such speed that it's not extreme to say the experience was like flipping a light switch. And no residual pain at any level.

Convenience, being a pill; less expensive compared to Imitrex injection (about $3/pill). And, the doc can give you a sample (free) and you will know with 1-3 uses whether it's effective for you.