Sameh M. Hakim: Warfarin for Refractory Chronic Cluster Headache: A Randomized Pilot Study. Headache. Published Online : 11 March 2011
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Interesting!!

I first posted this abstract about 2005. Clear that this approach has not gained much attention.
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J Headache Pain. 2005 Oct;6(5):417-9. Epub 2005 Aug 1. 


Warfarin as a therapeutic option in the control of chronic cluster headache: a report of three cases.

Kowacs PA, Piovesan EJ, de Campos RW, Lange MC, Zetola VF, Werneck LC.

Headache Section, Neurology Division, Internal Medicine Department, Hospital de Clinicas, Universidade Federal do Parana, Rua General Carneiro 181/1236, 80060-900 Curitiba, Brazil. cefaleia@hc.ufpr.br

Chronic cluster headache remains refractory to medical therapy in at least 30% of those who suffer from this condition. The lack of alternative medical therapies that are as effective as, or more effective than, lithium carbonate makes new therapies necessary for this highly disabling condition. Based on a previous report, we gave oral anticoagulants to three patients with chronic cluster headache. Two of them remained cluster headache-free while taking warfarin. In the third patient, the use of warfarin for three weeks initially increased the frequency and intensity of cluster headache attacks but subsequently induced a prolonged remission. In spite of the paucity of data available, oral anticoagulation appears to be a promising therapy for chronic cluster headache.

Publication Types:
Case Reports

PMID: 16362716
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"What is warfarin?

"Warfarin is an anticoagulant (blood thinner). Warfarin reduces the formation of blood clots by blocking the formation of certain clotting factors.

"Warfarin is used to prevent heart attacks, strokes, and blood clots in veins and arteries."

I hope this isn't the last we hear from the good Dr. Hakim will all the problems in Egypt. 

It would be interesting to see the results of a similar study of chronic cluster headache sufferers refractory to pharmacological management being treated with Omega 3 Fish Oil, vitamin D3 and calcium citrate supplementation.

If it worked, it would appear to be a preferable alternative to taking warfarin (coumadin), a.k.a. rat poison.

Take care,

V/R, Batch

Batch wrote on Mar 13^th, 2011 at 11:00am:

It would be interesting to see the results of a similar study of chronic cluster headache sufferers refractory to pharmacological management being treated with Omega 3 Fish Oil, vitamin D3 and calcium citrate supplementation.

Yes please! - Any RCT planned yet?

I'm working on it now.

A brief commentary on this article at START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE adds this information: >>>It's unclear what the underlying mechanism may be, says Dr. Hakim, but it's unlikely to involve any direct anti-inflammatory action. "An apparently more plausible hypothesis may be related to vitamin K," he suggests, "which seems to exert biologically relevant actions on dendritic and neuronal metabolism."<<<

Made me think of your D3 thread, which I have been reading with great interest and discussing over at the Clusterbusters board.  My first post here, so an opportunity to say THANK YOU to all of you for your contributions to one day beating CH.

CHfather,

Thank you for the kind words, but we're still a long way from getting the anti-inflammatory regimen into a clinical trial. 

It took a lot of hard work and a quarter million dollars to get the demand valve method of oxygen therapy that uses flow rates that support hyperventilation into a formal pilot study...  and that was three years after we collected enough statistically significant data on 366 aborts to prove it's efficacy and safety with abort times that rivaled imitrex injections, but without any adverse effects.

I'm far from harboring any notion the anti-inflammatory regimen is fully effective...  I know better.  Granted this is little more than an uncontrolled survey and some of the success can easily be attributed to other medications still being taken or an end of cycle for the episodic CH'ers.  That said that, this regimen continues to demonstrate a raw efficacy of 80% with either a significant reduction in the frequency and severity of CH, or a CH pain free remission. 

What we've also found of equal interest in the information gained from CH'ers who have not had a significant improvement with this anti-inflammatory regimen after more than a week, is that they all share one or more of the same comorbidities. 

These comorbid disorders include cardiac, renal, and thyroid insufficiencies as well as COPD and diabetes.  Moreover, these same CH'ers also tend to be refractory to other CH preventatives and abortives. 

There appears to be concurrence on at least some of the disorders we noted as a multivariate analysis conducted by Zidverc–Trajkovi JJ et al. and reported in an article titled Comorbidities in cluster headache and migraine, Acta Neurologica Belgica, 04/18/2011, where they found chronic sinusitis and diabetes mellitus, adjusted by gender, age and duration of headache, are more frequently associated with cluster headache(CH) than with migraine.

The interesting thing about the comorbid disorders we've noted with respect to the anti-inflammatory regimen is they all have the potential to lower arterial pH. 

The sinusitis reported by Zidverc–Trajkovi JJ et al. is also of interest as it may be an indication of an inflammatory reaction that could easily encompass the sphenopalatine ganglion and possibly spread to the trigeminal ganglion as the two nerve bundles are directly connected to each other by a branch of the trigeminal nerve.

What all this points out to me, is that as cluster headache sufferers, we need to make sure a more holistic approach is taken in treating our disorder to include looking at other comorbid disorders that can easily prevent CH medications from working effectively.  In short, unless the comorbid disorders are treated at the same time, it's entirely possible the medications prescribed for our CH will not have the desired therapeutic effect.  Some food for thought...

Take care,

V/R, Batch

Fascinating, Batch, and again, I can't begin to thank you enough for all you (and others) are doing.  I was only posting that warfarin information in case the vitamin K element might add something to your assessment.

Over at C'busters.com, I (and others) have tried to make sure that everyone is aware of the D3/O-3/citrate/(lemonade) option, and there have been some nice success stories there, too (everyone is referred to the thread here at ch.com if they're interested in really understanding it all).

It's not me, but my daughter, who's the CH sufferer (episodic).  I spend an average of a couple hours a day at these boards, trying to help chart the best course for her and share what I can with others because, as you say and demonstrate, theory-based experimentation and investigation are the way out from under CH.  I've posted this comorbidity study along with your explanation of its importance over at c'busters.com.

Jerry

The full story about Dr. Hakim's Warfarin study, free full text at MedScape, free registration required:

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I've just returned from my neuro appointment with Dr. Dale Carter (speaker at last years Cluster Buster conference in Portland, Or).

She did multiple blood tests and the one that stood out was folate deficiency (supplemented name is folic acid) along with larger than normal red blood cells.

I also remembered that the very first attack followed a severe and high flowing menstrual cycle that continued for 29 days.  I don't remember (age 15) what if any tests were done, but I do remember the doctor gave me 2 shots of vitamin k in either side of my hips (that hurt like hell!).  I'm so curious if all this was/is interrelated.

So today I do a google search on the subject and up pop's this thread!  Wahlah!  Again cluster headache sufferers working behind the scenes trying to do whatever we can, naturally and intelligently to find a reduction or remission in our pain cycles.

I'm so thankful for these sites and your continued participation in "Citizen Science".

I'd been supplementing with 10,000iu of D3 for 4 months before the appointment and the results were at the low end of "normal".  Same with the magnesium.  Makes me wonder about absorption abilities within our systems too.

Any thoughts on that?

Going back to read more!!!!  Thanks gentlemen :)