I read a post just the other day.  Poster said he OD'd and had a Heart Attack. 

I have in the past used "expired" Zomig spray, It worked just fine and had been expired for 3 years.  Be careful and PF wishes.\

Thomas

icculus wrote on Jun 8^th, 2008 at 5:25pm:


On the bright side, you may find that your attack frequency decreases when you run out of Imitrex.

I hear ya about walking away from a vial of relief sitting there. It ain't easy.

1: Headache. 2004 Jul-Aug;44(7):713-8. Related Articles, Links   

   
Subcutaneous sumatriptan induces changes in frequency pattern in cluster headache patients.

Rossi P, Lorenzo GD, Formisano R, Buzzi MG.

Headache Centre, INI Grottaferrata, Rome, Italy.

OBJECTIVES: To document the relationship between the use of subcutaneous (SQ) sumatriptan (sum) and a change in frequency pattern of cluster headache (CH) in six patients. To discuss the clinical and pathophysiological implications of this observation in the context of available literature. BACKGROUND: Treatment with SQ sum may cause an increase in attack frequency of CH but data from literature are scant and controversial. METHODS: Six CH sum-naive patients (three episodic and three chronic according to the International Headache Society (IHS) criteria) are described. RESULTS: All six patients had very fast relief from pain and accompanying symptoms from the drug but they developed an increase in attack frequency soon after using SQ sum. In all patients, the CH returned to its usual frequency within a few days after SQ sum was withdrawn or replaced with other drugs. Five patients were not taking any prophylactic treatment and SQ sum was the only drug prescribed to treat their headache. CONCLUSIONS: Physicians should recognize the possibility that treatment of CH with SQ sum may be associated with an increased frequency of headache attacks.

Publication Types: 
Case Reports

PMID: 15209695 [PubMed - indexed for MEDLINE] 



best of luck...hang in there,
Bobw

Funct Neurol. 2000 Jul-Sep;15(3):167-70. 


Sumatriptan overuse in episodic cluster headache: lack of adverse events, rebound syndromes, drug dependence and tachyphylaxis.

Centonze V, Bassi A, Causarano V, Dalfino L, Cassiano MA, Centonze A, Fabbri L, Albano O.

Dept of Internal Medicine and Public Medicine, University of Bari, Italy.

This observational study was designed to examine the pattern of sumatriptan use in patients with cluster headache using more than the recommended daily dose of subcutaneously injected (s.c.) sumatriptan. Thirteen patients suffering from episodic cluster headache were asked to record the characteristics of their attacks and drug intake for 1 year. All reported a high daily frequency of attacks (more than 3 per day) and the related overuse of s.c. sumatriptan. The results show that the overall incidence of adverse events among patients receiving sumatriptan injections for the treatment of cluster headache is low. The extended administration of this drug in episodic cluster headache did not result in tolerance problems or tachyphylaxis. Only 4 patients experienced minor adverse events and recovered more slowly than the others. They suffered from migraine without aura and cluster headache, and showed a family history of migraine. Even though they must be viewed with caution, due to the observational nature of the study and the low number of patients included, these results suggest that the profile of sumatriptan may differ in cluster headache compared with migraine.

PMID: 11062845 

Headache. 2004 May;44 Suppl 1:S20-30.
Cardiovascular tolerability and safety of triptans: a review of clinical data.

Dodick DW, Martin VT, Smith T, Silberstein S.

Department of Neurology, Mayo Clinic Scottsdale, AZ 85359, USA.

Triptans are not widely used in clinical practice despite their well-established efficacy, endorsement by the US Headache Consortium, and the demonstrable need to employ effective intervention to reduce migraine-associated disability. Although the relatively restricted use of triptans may be attributed to several factors, research suggests that prescribers' concerns about cardiovascular safety prominently figure in limiting their use. This article reviews clinical data--including results of clinical trials, postmarketing studies and surveillance, and pharmacodynamic studies--relevant to assessing the cardiovascular safety profile of the triptans. These data demonstrate that triptans are generally well tolerated. Chest symptoms occurring during use of triptans are usually nonserious and usually not attributed to ischemia. Incidence of triptan-associated serious cardiovascular adverse events in both clinical trials and clinical practice appears to be extremely low. When they do occur, serious cardiovascular events have most often been reported in patients at significant cardiovascular risk or in those with overt cardiovascular disease. Adverse cardiovascular events also have occurred, however, in patients without evidence of cardiovascular disease. Several lines of evidence suggest that nonischemic mechanisms are responsible for sumatriptan-associated chest symptoms, although the mechanism of chest symptoms has not been determined to date. Importantly, most of the clinical trials and clinical practice data on triptans are derived from patients without known cardiovascular disease. Therefore, the conclusions of this review cannot be extended to patients with cardiovascular disease. The cardiovascular safety profile of triptans favors their use in the absence of contraindications.

Publication Types:
Review

PMID: 15149490 [PubMed]

great advise/insight...

this sight is simply amazing, actually you people are amazing.

the 1/3 injection doesnt seem to pack enough punch, hopefully 1/2 an injection does the trick.  I will also look into zomig.  any problems mixing the zomig and imitrex?

Now its time to teach my new Dr. about CH and O2. (my old dr. who was fantastic, got caught w/ an intern).

thanks again

Giovanni wrote on Jun 9^th, 2008 at 8:20am:


As always, care to be used in word choice when we talk about medications. "Dependent" implies a chemical association, resulting in an inherent urge to use the drug.

If the injection is sitting there and the O2 hasn't worked, or the Red Bull for that matter, making the choice between withstanding a full on CH and not taking an injection becomes a choice that is more difficult to rationalize. A much more cognitive, albeit a degree of reliance, but not "dependence".

Or am I splitting hairs....?

Scott

I agree with all of you.  Tried O2, red bull and then I'll reach for the Zomig or imitrex in a heart beat.  The more Zomig or imitrex I USE the more I need--the longer the cycle (in my epsodic days).  My experience.

John 

For the injection of imitrex I never use a full dose. I use a 0.5 ml insulin syringe and typicaly ise 1/4 of the single dose vial.  It takes a bit longer for it to work but it stretches the trex and reduces chanced of rebound.  For all the meds we take I suggest minimal dose to do the job.

-P.

Have your doc prescribe you Imitrex in vials, with syringes. That way, you can fill your syringe with 1/3 of a shot (each vial is a single dose), or 1/2 shot, or a full dose.

Paul, I've taken less than a 1/3 shot in the past, and it has worked. I notice that when I'm really getting slammed, 1/3 of a shot doesn't quite cut it, so I go to 1/2. When I'm in high cycle, I have to use a full shot. Then I also use more than directed, with my neuro's approval, but when it gets to that point, I get the pred taper going.

I've never noticed rebounds while using imitrex, myself, but I know a lot of people get them. If you can split your shots, the possibility of having a rebound headache lessens. I've gotten them from taking OTC meds, like ibuprofen.

I've used outdated trex, even from 2004, this year, and did not have any adverse effects at all. I did not notice it having lost any strength, but I keep my trex in a climate controlled (somewhat) place, even temps, in the dark.

Whatever you do, do not mix any triptans, always wait 24 hours between using different kinds.

But, your doc can prescribe you trex in vials, so you don't have to use the q-tip trick. I explained to my neuro that I was splitting the shots, and would he give me a script for vials. he didn't know they came in vials, but did some quick research, and I had a script when I left his office that day. Remember to let your doc know to give you as many extra syringes as you will need, for splitting the shots, if a script is required where you live, with a few spares just in case. I've dropped them on the floor, and accidentally stuck myself with them before dispensing the trex...  .

Hi all, I have been lurking for the last 5 years, but haven't had much reason to participate, THANKFULLY. 42 Years old, CH's started at age 11, back in 1977. Doctor said they were sinus headaches. Had yearly cycles in spring for 8 to 10 weeks, usually 1 headache per day at between 8-9 am. I don't know why, but my headaches really like the mornings. Finally got diagnosed at age 23 when my sister, who worked for a neurologist suggested that I come into their headache clinic. I still remember his words: "you definitely have cluster headaches. Why did you wait so long to come in?". Nobody took me serious, that's why.  I had never heard of the term "cluster headache". As I look back, it really makes me sad that I had 12 years of yearly cycles and I suffered 100% of the brutality of each one of those headaches. Sad because I can't imagine one of my kids having to suffer even one of them.

So I was finally introduced to Caffergot and Sansert in the late 80's. What a Godsend! The Caffergot took a long time to get into my system, but I found if I took it on an empty stomach when I first felt a shadow, I would get relief for about half of my headaches.  It would never abort a headache once it began though. And the side effect was horrible nausea for the rest of the day. Better than the headache though. Then came Imitrex pills, but again they only worked at the first sign of a shadow, and again on an empty stomach. No nausea though....woohoo. I could never get the pills to abort a full blown headache. In my 20's the remission periods were going to 2 years, but the cycles were still the same.

Now as I have gotten older, my remission periods have been 4 years this time and 5 years the time before that. I feel so blessed and I hope this gives many of you hope that this crap will diminish for you too. My cycle seemed to be a bit shorter too (back in '04), but that was the first time I was given Prednisone, Verapamil AND Imitrex injections. I had to beg for the injections because Kaiser was insisting that Maxalt was superior. Maxalt didn't do squat except save Kaiser money. During an attack, my wife drove me back to the doctor's office. A Physician's Assistant (of all people) looked up everything he could on the internet, put me on 02 on the spot in the office and it aborted the headache in 20 minutes. Put me on Imitrex injections and they aborted every single headache I had for the remainder of the cycle, which was only about 2 weeks longer.

Now I'm in a new cycle and I am having a hard time getting 02 prescibed. The MD has no clue about CH's. I had to bring info for him. Didn't show up in my file because they went from paper files to computer back in 2005. I just can't believe that some are still in the dark ages about this.

This is the wrong forum to tell my story, but I was on a roll. Was checking here because I have 4 expired Trex vials from '05 and want to still use them so I can stretch it out until I get an ok for 02.

Great resource!

NEVER MIX TRIPTANS
EVER
You will know about triptan overdose then.
Mix it up, hit the beast with 02, then caffeine, then trex. Delay the trex anyway you can. Try to decrease injection frequency. The trex rebounds suck. Your one step ahead of the demon. Hope the dopeymax kicks in soon. Maybe a transitional med like pred or lithium till the prevent kicks in. Just trex doesn't quite get er done.
all the best
thebb