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Triptan Ramp Up (Read 2155 times)
Giovanni
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Triptan Ramp Up
Jun 22nd, 2008 at 8:44pm
 
I’m trying to compare a few notes on triptan drugs; imitrex, zomig, and others.  During the last few usages (in particular), I’ve noticed an accelerated/rapid ramp up in pain prior to the drug kicking in.  Kind of like the beast trying to get in its last gasp.  Today was a dozy.  I was out on the motorcycle stopped at a tire kicking place and I felt the ut oh feeling.  I quickly had taken the Zomig and the pain level quickly ramped up to about a 7 or 8 and stayed there for a period of time.
Does this happen to any of you?

John  Undecided
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Chappy
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Re: Triptan Ramp Up
Reply #1 - Jun 22nd, 2008 at 9:15pm
 
Zomig nasal spray works for me, where imitrex did not.  Mayo's head of neurology told me Zomig was proven more effective on CH in studies.  I never tried the injections, though, which are probably better than nasal sprays.

Daily triptan use have been proven pretty unequivocally to increase both the frequency of hits and duration of a cycle.  I havens seen any studies saying they increase the intensity, or make it ramp up faster.  However, if you had already aborted one within a few hours, then that may have been a rebound headache.  My personal experimce is that rebound headaches come on fast, peak high, and are shorter-lived.

Still, killing one hit with Zomig doesn't compare to knocking out 3-5 days of hits with rc seeds.
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jon019
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Re: Triptan Ramp Up
Reply #2 - Jun 22nd, 2008 at 10:38pm
 
Chappy wrote on Jun 22nd, 2008 at 9:15pm:
Daily triptan use have been proven pretty unequivocally to increase both the frequency of hits and duration of a cycle.  



Hi Chappy,

That's a pretty bold statement. There are some folks here that may agree. My neuro believes that. Myself, I am now chronic after years of episodic and it is coincidental with my increased use of triptans. Still, I don't know it to be true and I haven't seen any studies that say so. My apologies if I have missed the posts providing it. Please, can you provide some references?

Myself, I question whether I would be sane without Zomig NS. After many years of the battle and many meds, besides O2, that's the one.
If I need to rethink my reliance I will, but I gotta have more than anecdotal.

Regards,

Jon
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Chappy
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Re: Triptan Ramp Up
Reply #3 - Jun 23rd, 2008 at 12:45am
 
Jon,

Yeah, there was a pretty definitive study I've seen posted a couple of times.  I'll search for it when I'm at my PC, unless Mr. Johnson sees this thread and beats me to the punch.

Anecdotally, within the Buster community new people have to stop all meds for 5 days before trying the new treatment.  I've heard many people say that they were afraid to give up triptans, but when they did they were surprised that things quickly improved.

Anyway - I'll look for that study (or studies).
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Giovanni
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Re: Triptan Ramp Up
Reply #4 - Jun 23rd, 2008 at 8:12am
 
I appreciate your responses.  Right now my preferred choice of abortive is oxygen, but the problem I’m having is that after using it the next headache is anywhere from 30 minutes to 1 ˝ hours later.  I would have to be tethered to the tank all the time in my current state.  The Zomig will give me anywhere from 6 – 12 hours pain free.  I use the O2 for in-between the Zomig doses and end up with about 2 doses per day.  I might suck it up and stay home for a couple of days and use O2 exclusively and detox from the Zomig and see what happens.  My sleep prior to this high cycle has been almost non-existent………..O2 go to sleep, wake up hour later, O2 back to sleep, etc. With the Zomig, I can sleep all night uninterrupted. 
Having said all of this, I subjectively believe that triptans extends cycles and will cause rebound headaches.  I’ve tried the seeds, prior to this high cycle, (I was detoxed) for a period of weeks with the proper intervals and with me the switch seemed to be turned on in the wrong direction.
I see the neurologist in about a month and will try lithium in addition to my current verapamil.  With me, I feel like I'm running out of treatment options.
John
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Chappy
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Re: Triptan Ramp Up
Reply #5 - Jun 23rd, 2008 at 12:30pm
 
Jon: My Google skills have failed me, and I can't find that study.  I know it's there, so I've asked Bob Johnson about it, since he seems to be Johnny On the Spot with research...

John:
Quote:
I appreciate your responses.  Right now my preferred choice of abortive is oxygen, but the problem I’m having is that after using it the next headache is anywhere from 30 minutes to 1 ˝ hours later.


That's been my experience exactly.  Oxygen takes 20 minutes to abort for me, and the headache starts to return within minutes.  I've heard that with a good preventive, or even with busting, oxygen use becomes more effective so I've kept the tank around and try it every now and then.

Zomig NS also gave me 4-6 hours relief, and was the only thing that worked at first.  My insurance will only cover 6/mo, and at $20 each I just couldn't justify it.  Topomax, Verapamil, and various other things failed (though Topomax helped for a couple months), so the neuro gave me Lithium.  I decided, like you, to try rc seeds before I took the Lithium.

Quote:
with me the switch seemed to be turned on in the wrong direction.


I've had that happen - depending on the dose, CH activity seems to increase for a few days after dosing.

I've been trying busting methods for a few months, and it didn't work right away.  I figured that even the possibility of actual remissions periods is worth trying whatever it takes to make it work.  I usually get 8-20 hits per day, with 4 1.5hr kip 7-9s every night like clockwork, so I know right away if something's working.  With some experimentation I got some 5-8 day pain free periods.  I'm now getting about 3 days nearly pain free for each dose, but I've also noticed from my logs that the average intensity of headaches has reduced dramatically.

I'm hoping over time this trend will continue.  If not, then it's on to Lithium for me too.
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jon019
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Re: Triptan Ramp Up
Reply #6 - Jun 23rd, 2008 at 12:48pm
 
Chappy, thank you, I want to see it, then I don't, but I should...if that makes any sense.

And Gio

Giovanni wrote on Jun 23rd, 2008 at 8:12am:
 The Zomig will give me anywhere from 6 – 12 hours pain free.

I get the same mileage!


I use the O2 for in-between the Zomig doses and end up with about 2 doses per day.

No matter what, even if I have to ride out a major hit, I never use more than 1 Zomig per 24 hrs. Intuitively knew, even when I started several yrs ago, that more triptans than that wasn't good for lots of reasons.
.

I might suck it up and stay home for a couple of days and use O2 exclusively and detox from the Zomig and see what happens.  

Worth a try!


My sleep prior to this high cycle has been almost non-existent………..O2 go to sleep, wake up hour later, O2 back to sleep, etc. With the Zomig, I can sleep all night uninterrupted.  

Now that there could have been written by me. My EXACT experience.

What I learned, the hard way, was the following:

An energy drink, even 1 hr or less prior to bed, doesn't keep me awake. Suppose I have become accustomed.

Melatonin 9-15 mg, just prior to bed knocks me loopy and out.

When the every hour wake ups happen, I used to rage and get so worked up with adreniline that sleep became impossible. That wasn't working so I decided to play my own mind games with the beast. Now, I wake, hit the O2, do deep breathing, and try like hell NOT to FULLY awake. No thinking, no fear, no anger. Rather than curse the misfortune, I am grateful that "now I get another hour of sleep". It's very calming and I usually drift right off. Another hour later, I do the same. It's all very tiring but much less so than if I fight all night long.

And, for some reason I cannot fathom, have found that O2 works on 95% of these nightime hits, During the day, its more like 65%.

As I said, MY experience. Hope there may be a tidbit or two that might help. My prayers that you find relief.

Regards

Jon


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