if I fancy a night on the town or I want to go to a party and let my hair down - will a pre-emptive 50mg imtrex/imigran pill - let's say taken an hour before I start drinking - counteract the vaso-dilatory effects of alcohol? - anyone tried this successfully?

I've never used the oral imitrex. When I'm on cycle I just skip the alcohol, the attacks it causes tend to be doozies.

Joe

Guiseppi wrote on Feb 23^rd, 2011 at 8:12am:

I've never used the oral imitrex. When I'm on cycle I just skip the alcohol, the attacks it causes tend to be doozies. Joe

yeah I know I should just stay away from it but I use alcohol quite frequently when off-cycle and not being able to enjoy it at all on-cycle is a real bug-bear of mine

I hear you, I'm a huge fan of darker micro brew beers, I LOVE the really hoppy IPA's, give me Wild Turkey 101 or Jim Beam, I love me the blended canadians, Crown Royal etc., then we get to the Scotches! ;D ;D

Just one more of the beasts annoying side effects...my alcohol cabinet gathers dust! :'(

Joe

Interesting to note that he is saying that the primary mode of action is NOT as a vasoconstrictor but on its effect on the central nervous system. Doesn't change our appreciation of this class of meds but suggests we need to change how we think about the nature of CH.
==============================
Handb Exp Pharmacol. 2007;(177):129-43.   


Serotonin receptor ligands: treatments of acute migraine and cluster headache.

Goadsby PJ.

Institute of Neurology, Queen Square, London WC1N 3BG, UK. peterg@ion.ucl.ac.uk

Fuelled by the development of the serotonin 5-HT(1B/1D) receptor agonists, the triptans, the last 15 years has seen an explosion of interest in the treatment of acute migraine and cluster headache. Sumatriptan was the first of these agonists, and it launched a wave of therapeutic advances. These medicines are effective and safe. Triptans were developed as cranial vasoconstrictors to mimic the desirable effects of serotonin, while avoiding its side-effects. It has subsequently been shown that the triptans' major action is neuronal, with both peripheral and central trigeminal inhibitory effects, as well as actions in the thalamus and at central modulatory sites, such as the periaqueductal grey matter. Further refinements may be possible as the 5-HT(1D) and 5-HT(1F) receptor agonists are explored. Serotonin receptor pharmacology has contributed much to the better management of patients with primary headache disorders.

PMID: 17087122 [PubMed]
========
J Clin Neurosci. 2010 Mar 11.

What has functional neuroimaging done for primary headache ... and for the clinical neurologist?
Sprenger T, Goadsby PJ.

UCSF Headache Centre, Department of Neurology, University of California, 1701 Divisadero St, Suite 480, San Francisco, CA 94115, USA.

Our understanding of mechanisms involved in primary headache syndromes has been substantially advanced using functional neuroimaging.

THE DATA HAVE HELPED ESTABLISH THE NOW-PREVAILING VIEW OF PRIMARY HEADACHE SYNDROMES, SUCH AS MIGRAINE AND CLUSTER HEADACHE, AS BRAIN DISORDERS WITH NEUROVASCULAR MANIFESTATIONS, NOT AS DISORDERS OF BLOOD VESSELS.

PMID: 20227279 [PubMed]

well, I had a packet of oral imigran/imitrex in the cupboard and some beers in the fridge so... purely in the interests of scientific enquiry - I took a 50mg pill when I got home from work and cracked open a beer a half-hour after

have had 5 beers - 11 units of alcohol and no pain - I'm most definitely on-cycle and typically even one beer would set me off ... interesting

I'm not advocating frequent use of pre-emptive sumatriptan to get round the alcohol issue but might be a useful thing to have in the toolbox - although a little bit more field research is required I think - I'm only doing it for the team  [smiley=beer.gif]

No criticism intended. Our collective experience is so varied, yet extensive, that it's not a surprise when some unorthodox treatment works.

Now--if you continue this approach for some months--and it continues to work. THEN you may have something to pass on to the research bunch.

Bob Johnson wrote on Feb 23^rd, 2011 at 7:34pm:

No criticism intended. Our collective experience is so varied, yet extensive, that it's not a surprise when some unorthodox treatment works. Now--if you continue this approach for some months--and it continues to work. THEN you may have something to pass on to the research bunch.

no criticism inferred 

as a matter of interest - is it accepted that the only action of alcohol as a trigger is as a vaso-dilator - or could there be more subtle neuro-mechanisms at work?

Don't know beyond the realization that alcohol is a more complex drug, in it's affects, than dilation.

It appears that we are a long way away from knowing the impact of the hypothalamus, beyond the recognition that it, somehow, appears to trigger CH attcks.

One of my new favorite products is N-ACETYL-L-CYSTEINE (NAC)  Alcohol lowers levels of an antioxidant called glutathione, this stuff helps to boost it back up.  I have definitely found this to be helpful when I'm getting shadows but still want a drink.  Definitely not an option when you're in a full blown attack though.  The company I get it from has a time release version so it'll stay in your system for about 4 hours.