I've been posting in Batch's D3 thread about my wife's CH coming back for only the third time ever, but figured I'd start a new thread as to not get that one off topic.  :-)

My wife has her CH for only her third time, (2014, 2015, and nothing again until now).  Her Neuro finally admitted that these were likely CH this time around after ignoring her reported symptoms the last two times.  She's on a steroid taper and Sumatriptan tablets to abort.  (They offered nasal, but the tablets actually worked reasonably well for her last time, so for $1.80/100mg tablet she went with those) 

She's taken the tablets two nights in a row and aborted both CH in 15 minutes or less. She just told me that the Neurologist said not to take more than 2 100mg Imit tablets per week because the headaches would get worse?  I've tried to do some research on this and this seems to be:

a) more geared towards migraine
b) ignoring dozens of examples of people taking Imitrex every day and not losing effectiveness

The article below seems to highlight that the research behind the "2 per week max Imitrex" is spotty at best.

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

Anyone have any personal experience with Imitrex (specifically tablets) losing effectiveness with daily use?  Anyone else's Neuro also giving this same guidance with a 2 day per week max?  If she has to go the next 5 days without Imitrex she will have zero defense if she gets hit, (which she is nightly), and I'm afraid we're going to end up in the ER like we did back in 2015. 

Any feedback is appreciated!

MJ,
I believe 200mg/day is the upper limit for sumatriptan. I can’t speak to the loss of effectiveness, but it may be more about serotonin syndrome. Look it up. Not good. At any rate, I haven’t experienced any loss of effectiveness from using sumatriptan daily. But I still try to limit it to nighttime, when I’m trying to sleep, or maybe a low level daytime attack that I can’t abort with other means. I have found that cutting the 100 mg tabs in half is usually enough for me. She might try that. Also, if she hasn’t tried oxygen, I highly recommend it. Once I learned how to use it correctly, I need far fewer triptans.
Take care.
Patti

Hi MJ.....anecdotally over the years here sumatriptan has been reported to negatively affect cycles and cause rebounds. everyone is different so you really only know with experience. 2 per week max sounds way lower than many folks use...but I still think wise advice from the neuro...

...using as a prevent is uncommon and doesn't work for most...but some do successfully, like when travelling by air. and a tablet is useless for aborting a hit... so it would be good to have injectable on hand if the hits start getting to screamer level (tho experience will show once a hit a bad hit is underway triptans and O2 unlikely to work).....

...my best success is with Zomig 5 mg nasal spray...99% effective...same high price. for ME nunna the ooky side effects of suma….

….some have had success switching between different kinds of triptans....I'm surprised your neuro didn't suggest/prescribe that as he/she sounds well informed. caution: NEVER mix different triptans within less than 24 hrs...

...and I'm with pattik….proper use of O2 reduced my triptan use to almost none...

best

jon

Thanks Pattik and Jon.  She's taken it two nights in a row as an abortive, and it's worked both times.  (Last night took a little longer)  No rebound headaches or increased frequency to speak of.  I'm praying the D3 kicks in and starts to prevent these but definitely still need a backup.

We are traveling today and tomorrow. (By car)  I'm hoping that having the option to take the pill tonight and tomorrow night if needed will get her through to Monday when she can call her Neuro if she's still getting hit and discuss O2.  I'm guessing 100mg a day for 4 days in a row won't cause these "over-medication" headaches the doc is warning about?  Thanks again!

Daily use of triptans, including Imitrex, has not been thoroughly studied, but there's evidence suggesting that it's effective, generally safe, and does not cause rebound attacks.

Last time I checked, there was at least one company working on a long-acting triptan drugs, especially designed for daily use. I know for a fact there headache specialists sometimes use existing long half-life triptans for prevention, usually with other prophylactics. I got such a treatment once.

It is speculated that the recommendations for Imitrex weekly usage limit originates from health insurance companies. I strongly recommend reading this (the author is a headache specialist):

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

Here down under, Imigran and Imigran FDT 50mg tablets come in a pack of 4, so I found going back too the pharmacy for a repeat more than once a week was always questioned, so I would go too different pharmacies to get my repeat script filled to avoid all the aggro.

Cheers Hoppy

...interesting Hop'....let's discuss....is it the pharmacist doing it because of medical concern... or as shooky indicates... insurance driven that puts the pharm in the middle?

G'day jon, good  :question, we don't have insurance here in oz that covers pharmaceuticals, so a pack of 4 Imigran will set you back $47.00, but when retired like myself, your looking at $6.40 a script  :). As to why they query more than 200mg a week is because of medical concerns they have, and I've had my battles with them that no more than 300mg/day is perfectly safe according to my GP, so I'm glad now I'm on the vitamin D regimen and no sign of the beast during my Fall cluster period.

Cheers Hoppy

My experience with sumatriptan is that the tablets didn't work but the injections are fantastic.   However, they do cause rebound headaches -these are headaches of the "ordinary" kind that can be taken care of with OTC headache tablets.

I've been off this board for a few years but remember going round and round the Sumatrapin arguement. All I can offer you is my experience.

Rebound headaches dont happen. If you take a shot for a monster and the pain comes back? Just means it woulda been a very bad night without the shot.

I have a neuro who prescribes me a 30 day supply of two shots a day for a 30 US dollar co-pay.  My preventative quit working (verapamil) and Lithium was almost worse that the attacks because its everyday side effects turned me into a zombie. Only good news about going off the preventative is I confirmed I still get attacks in clusters and not year round...which is heaven.

So my Strategy now (within a bit of reason) is keep filling those scripts for the shots. I have bags of them in a cool dark place. Been around this hellish condition long enough that I can tell when one is coming. Many call it a shadow and I think that is the perfect description. Then I wait. Might drop a 100mg tablet if I dont think it's too late...if it starts to intensify I dont hesitate and give myself a poke. I have often done 2 to 3 a day back to back for over a week. Once did 5 shots. Only happens if I am slow to get a pred taper.

Need the right doc. And do some research on the trials done during the initial development of sumatriptan. My life was so much better with no preventative during the quiet time and I had no panic when a cycle hit because I have a ton of shots.

Then I get lung cancer. Good news...should be curable with Surgery next week. My biggest fear...feel a cycle coming on and I WILL take as many shots as I need to while in there if needed.

Bottom line tho.....Sumatriptan injections are friggen magic. O2 didnt work. Batches brew did nothing. A prick on the back of my thigh? Sweet relief in minutes.

Good luck all.