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Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Ergotamine or Verapamil? http://www.clusterheadaches.com/cgi-bin/yabb2/YaBB.pl?num=1351883206 Message started by Ngl on Nov 2nd, 2012 at 3:06pm |
Title: Ergotamine or Verapamil? Post by Ngl on Nov 2nd, 2012 at 3:06pm
Hello everyone. After 2,5 years I got another CH episode that have started about 10 days ago. I went to a neurologist today and was diagnosed with episodic CH (episodes stated 15 years ago and have 1 per year or so) .
He suggested ergotamine as a preventative, and I have another appointment with him tomorrow to bring a cardiogram in order to make sure it is safe for me to use ergotamine. Up to now, the only thing that works for me is Redbull or plain caffeine, if taken early enough. I have never tried O2, or any other medication apart from over-the-counter painkillers, since I have never been diagnosed with CH. After searching the forum, I found that ergotamine can be helpful, however I am concerned about the adverse effects it may have. I also understand that Verapamil is safer and usually prescribed first to prevent (and maybe treat) CH. So my intention is to ask for Verapamil instead of ergotamine and see how that works for me. Any feedback would be greatly appreciated! I also intend to ask for an O2 prescription if availiable, however it will be difficult for me to use, since I am working long hours and not in home most of the time. |
Title: Re: Ergotamine or Verapamil? Post by Ngl on Nov 2nd, 2012 at 8:28pm
Bob, I can't thank you enough for your quick response. You send me exactly what I needed for the appointment with the neurologist tomorrow. I think Verapamil is my best option, it looks very promising, especially for episodic CH. I am not sure I understand the difference between short-acting and sustained release formulations, is it about dosage and administering time, or rather about a two different sub-types of the same substance?
Btw I live in Greece and this was one of the few Headache Clinics I could find in my town. Maybe there are a couple more in hospitals, but the appointment there would be in 1 month or more, so I really need to get some help now since I already am trough an episode. I have been to many doctors before and it is really hard for me to find somebody specialized for CHs. This is the first doctor I find that has recognized that I suffer from CHs, he has previously treated CH patients and has a very good attitude, for me this is a major step ahead. Once again, thank you for your help Bob! PS: I have a message in the newbie section but that was 2 or 3 years ago. I will update it with the new info or maybe make a new one. |
Title: Re: Ergotamine or Verapamil? Post by Bob Johnson on Nov 3rd, 2012 at 8:51am
Verap comes in two form, quick acting and longer duration. Reason for using the short form is noted in the article.
Print out the PDF file, as well as the Verap article, for your doc. If he is open to accepting it, the information will help him appreciate the need for using other meds. This article is the latest evaluation of the major meds used for Cluster. (Many of us have had to educate our doc so that they could take care of us! It's quite striking how little education doc receive in med school around the issue of complex headache disorders--specially around Cluster. |
Title: Re: Ergotamine or Verapamil? Post by Ngl on Nov 3rd, 2012 at 9:32pm
Doc appointment results: Verapamil as preventative (short release form) 160mg/day to start with and increase it in a few days. Also rizatriptan (maxalt) as abortive if caffeine fails. Unfortunately there is no way the doctor can prescribe me oxygen for this condition.
First day of using Verapamil: No improvement at all, 1 hour after the 2nd dose I had a strong CH that lasted 2,5 hours :( Tomorrow I am taking Maxalt for sure. Hope to see some improvement the next days. Thanx for the support and info |
Title: Re: Ergotamine or Verapamil? Post by jon019 on Nov 3rd, 2012 at 10:38pm
Hi ngl...welcome aboard...you are home!
I'll be brief....verapamil takes several weeks...and perhaps several incremental dosage increases to be effective....I've been as high as 960-1040 mg/dy...480 seems to be the dose most report as effective...then you can save the probable limited supply of maxalt for breakthroughs... TOTALLY not understanding why O2 is not possible...a doctor who understands ch would be SMILING while writing the script for O2....and the birthplace of modern medical practice not having that available!!???...is astounding.... being away from home doesn't matter...I carry an e tank in my car...one in my office...or could cart it along if necessary...the FIRST time O2 aborts a seemingly inevitable agonizing hit...you will be bouncing off the frigging walls...and wondering...what took so long to get THAT?!!!!!! ...if ya can't get medical O2...then industrial...or perhaps the ubiquitous dive shops would be MY next stop..... Best, Jon |
Title: Re: Ergotamine or Verapamil? Post by Kevin_M on Nov 4th, 2012 at 6:14am Ngl wrote on Nov 2nd, 2012 at 8:28pm:
You've mentioned using the short-acting. That would have a lot to do with dosing and administering time. From Bob's article: Quote:
I take the sustained release and still divide the doses into twice a day. The short acting should be three times a day, every eight hours to be effective. Quote:
If you are taking one tablet of short-acting 160mg, you are essentially without a preventative 16 hours a day. Dividing it into 80mg twice a day will give longer but still inadequate coverage. This is about dosing and administering time. When you increase, probably another 80mg to 240, take it as 80mg every eight hours. Divide 240mg into three doses when using short-release. However, as Jon mentioned also: Quote:
My first time with verapamil took until 640mg to stop the runaway condition at the time, and I've been as high as around 900 a few times after, but presently holding at 480mg/day. This is why a prednisone taper is done at the outset, to give you time to get to an effective level. Without the predisone, an abortive should be understandably essential. Quote:
for unknown reasons Quote:
How many do you have? Inquire about a better supply of abortives so you don't have to scrimp and suffer through this slow increase of verapamil. Maybe ask for a change to Imitrex if you can get more in the nasal spray, or if injectables, use the Imitrex tip. Welcome, stick around. |
Title: Re: Ergotamine or Verapamil? Post by Bob Johnson on Nov 4th, 2012 at 7:29am
Verap takes several days to become effective and then you may have to adjust dosing to find what is effective for you.
Patience.... |
Title: Re: Ergotamine or Verapamil? Post by Ngl on Nov 4th, 2012 at 10:58am
Thanx for the replies guys,
Doc can't prescribe O2 because it is not approved for use to treat CHs by the national health system in Greece. The same goes for all other drugs, in fact, it is like CHs do not exist. I can of course buy an O2 tank and rest of the equipment privately if I can handle the cost. I will check that tomorrow. I started Verapamil short release form with 2x80mg doses and instructed to increase that after 5 days to 3x80mg. Should I ask the doc to increase the dose sooner? Also do you think that until I do increase the dose, I should break one 80mg dose into 2 40mg? I usually have 3 attacks per day, that normally can be reduced to 1 or 2 by using redbull/coffee in time. How soon did you guys increase Verapamil dose? Do you suffer from chronic or episodic CHs? |
Title: Re: Ergotamine or Verapamil? Post by Kevin_M on Nov 4th, 2012 at 11:09am Ngl wrote on Nov 4th, 2012 at 10:58am:
That is about the right rate to stick with. Quote:
If the tablets have a line in the middle, they can be broken in half, but keep at three times a day with short-acting. Quote:
The progress you are making is about right. You'll see in Bob's article about 120mg a week can be added. Just as gradual, 80mg every 4-5 days. The very same guidelines my doc gave. |
Title: Re: Ergotamine or Verapamil? Post by Bob Johnson on Nov 4th, 2012 at 1:06pm
Reread the Verap protocol again--my first reply.
|
Title: Re: Ergotamine or Verapamil? Post by Kevin_M on Nov 4th, 2012 at 1:40pm Bob Johnson wrote on Nov 4th, 2012 at 1:06pm:
It has directions for 40mgs. Quote:
Thanks Bob, the 40mgs on alternate days may be a better way to go. I've never worked with that small a quanity before. I postulated out 40 on alternate days = 80 every 4-5 days = 120/wk. |
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