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I need some advice Dr. took my imitrex away (Read 3070 times)
wewcaj
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I need some advice Dr. took my imitrex away
Oct 17th, 2008 at 10:19am
 
I had a light heart attack in 04 and My Dr. took my imitrex away. Imitrex is the only thing that has ever touched these beasts. I am into a severe group of clusters and was just wondering if anyone else has been able to obtain imitrex and has used it after a heart attack. If you suffer from these beasts you will know why I am grasping at straws and am willing to go against my Dr. advice on the imitrex. Please don't think I am on here looking for drugs.The same Dr. that took my imitrex has me using stadol nasal spray. I used it twice yesterday during a cluster, It had my head all srewed up, I could not even walk straight but it only barely took the edge off the cluster. Any help or opinions on imitrex use after a light heart attack will be greatly appreciated. Thanks Butch, my email is wwatsoniii@triad.rr.com
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« Last Edit: Oct 17th, 2008 at 10:21am by wewcaj »  
 
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Potter
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Re: I need some advice Dr. took my imitrex away
Reply #1 - Oct 17th, 2008 at 10:23am
 
   I just can't say enough bad shit bout Stadol and I can't say enough good stuff bout oxygen.

             Potter
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wewcaj
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Re: I need some advice Dr. took my imitrex away
Reply #2 - Oct 17th, 2008 at 10:27am
 
Potter the oxygen will help a litle with my clusters but not do a lot with them. I am an aircraft mechanic so the stadol really sucks when trying to do my job. Thanks for your reply
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gizmo
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Re: I need some advice Dr. took my imitrex away
Reply #3 - Oct 17th, 2008 at 10:37am
 
Have you tried energy drinks?

Oliver
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Re: I need some advice Dr. took my imitrex away
Reply #4 - Oct 17th, 2008 at 10:38am
 
What is your o2 delivery system?

              Potter
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wewcaj
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Re: I need some advice Dr. took my imitrex away
Reply #5 - Oct 17th, 2008 at 10:43am
 
15 liters full bore with a mask with bag on it for rebreathing, I actually today brought some oxygen generators home off one of the airplanes. It is a full mask with a seal you pull over your head. I will let you know how these work.

I haven't tried the energy drinks but a lot of these things get me while I am a sleep.
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gizmo
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Re: I need some advice Dr. took my imitrex away
Reply #6 - Oct 17th, 2008 at 10:49am
 
As soon as the beast wakes you from sleep chug down an energy drink (Red Bull, RockStar, ...).
The drink should have at least 0,4% Taurine and at least 80mg/250ml caffeine.
It won't always abort a hit but at least will push it down a bit.

Oliver
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« Last Edit: Oct 17th, 2008 at 10:51am by gizmo »  
 
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Re: I need some advice Dr. took my imitrex away
Reply #7 - Oct 17th, 2008 at 10:54am
 
Forgot to add: you can of course combine the energy drinks with O2!
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Re: I need some advice Dr. took my imitrex away
Reply #8 - Oct 17th, 2008 at 11:31am
 
Carefull with that Stadol it is also hard on your heart. I know from experience, Imitex and triptans do nothing for me so it has been one of the many. Ever try Prednisone (steriod).

Also many of us have gotten higher output O2 regulators, 25lpm, etc. and I have good results with that.        Good luck,  SLeepless, Don
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Though I walk through the valley of the shadow of the Beast , I  have O2 so I fear him not.
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Re: I need some advice Dr. took my imitrex away
Reply #9 - Oct 17th, 2008 at 11:39am
 
A number of us have had excellent results with this med. Personally, it always works 100% within 20-minutes and, other benefits, are it's in pill form making it easy to care/take, and the cost per dose is less than with Imitrex.

Print this medical journal abstract out. Will help to convince your doc that you are asking for something legit.


Headache 2001 Sep;41(8):813-6  

Olanzapine as an Abortive Agent for Cluster Headache.

Rozen TD.

Department of Neurology, Jefferson Headache Center/Thomas Jefferson University Hospital, Philadelphia, Pa.

OBJECTIVE: To evaluate olanzapine as a cluster headache abortive agent in an open-label trial. BACKGROUND: Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs. METHODS: Olanzapine was given as an abortive agent to five patients with cluster headache in an open-label trial. The initial olanzapine dose was 5 mg, and the dose was increased to 10 mg if there was no pain relief. The dosage was decreased to 2.5 mg if the 5-mg dose was effective but caused adverse effects. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose. RESULTS: Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and two patients became headache-free after taking the drug. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness. CONCLUSIONS: Olanzapine appears to be a good abortive agent for cluster headache. It alleviates pain quickly and has a consistent response across multiple treated attacks. It appears to work in both episodic and chronic cluster headache.



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Olanzapine has a brand name of "Zyprexa" and is a antipsychotic. Don't be put off by this primary usage. Several of the drugs used to treat CH are cross over applications, that is, drugs approved by the FDA for one purpose which are found to be effective with unrelated conditions--BJ.
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« Last Edit: Oct 17th, 2008 at 11:40am by Bob Johnson »  

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Re: I need some advice Dr. took my imitrex away
Reply #10 - Oct 17th, 2008 at 12:43pm
 
Butch,

You're between a rock and a hard place... Sorry man.

The only advice that I can give is, whatever you do, run it by your Cardio Doc first. I have used energy drinks with some success. Many of them; however, are loaded full of caffine and taurine.
  Some studies show that caffine is bad for your heart... On the other hand, there are those that report taurine is good for the cardiovascular system. Maybe it's a wash....

I cannot speak about heart attacks, as I have never had one. But I have had some MAJOR CHs. Even having said that, something inside me tells me to choose the CH over the heart attack.

In short, make sure that your GP and cardio doc and you are all on the same page..

I wish you many PFDs.

Jim
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Re: I need some advice Dr. took my imitrex away
Reply #11 - Oct 17th, 2008 at 2:27pm
 
don't walk but run from stadol.  my opinion from experience.
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wewcaj
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Re: I need some advice Dr. took my imitrex away
Reply #12 - Oct 18th, 2008 at 5:55pm
 
So far today I have been headache free. They have been hitting me around 3:00 PM in my sleep (3rd shifter). I was off work last night so I don't now what to expect tonight.  ShockedI must admit I didn't know what to expect from the red bull but when I awoke yesterday with the beast I did as you said. Chugged the red bull and then went straight to my oxygen. The headache wasn't aborted but was much much less severe than normal.
        I am on Prednisone , verapamil plus 2 500mg depakote before bedtime. I don't know if the medicine is starting to work some or if the energy drink is a miracle but let's just say I will not be without RED BULL by my side until these things leave again.
  Thanks for all of your help and support!!!!
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« Last Edit: Oct 18th, 2008 at 5:56pm by wewcaj »  
 
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gizmo
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Re: I need some advice Dr. took my imitrex away
Reply #13 - Oct 19th, 2008 at 4:21am
 
Well, I don't know either if it were the meds, the Red Bull or a mix of both but I'm glad that it worked.

Oliver
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Re: I need some advice Dr. took my imitrex away
Reply #14 - Oct 19th, 2008 at 5:28am
 
I would be very careful with Verapamil!

If you already have heart problems, Verapamil might make those worse and significantly raise the risk of you having another heart attack. Look here: Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register

Also using triptans (like imitrex) on a daily basis is NOT good for your heart. The cluster headaches won't kill you, but a heart attack might. Your doctor was right to ban the Imitrex!

- Best regards and PFDAN,
Rosa
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« Last Edit: Oct 19th, 2008 at 5:29am by Ungweliante »  
 
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Bob Johnson
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Re: I need some advice Dr. took my imitrex away
Reply #15 - Oct 19th, 2008 at 8:15am
 
Verapamil warning
« on: Aug 21st, 2007, 10:38am »   

--------------------------------------------------------------------------------

I posted this information recently in the form of a news release but more details here.
__________________

Neurology. 2007 Aug 14;69(7):668-75. 

 
Electrocardiographic abnormalities in patients with cluster headache on verapamil therapy.

Cohen AS, Matharu MS, Goadsby PJ.

Headache Group, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.

BACKGROUND: High dose verapamil is an increasingly common preventive treatment in cluster headache (CH). Side effects include atrioventricular block and bradycardia, although their incidence in this population is not clear. METHOD: This audit study assessed the incidence of arrhythmias on high dose verapamil in patients with cluster headache. RESULTS: Of three hundred sixty-nine patients with cluster headache, 217 outpatients (175 men) received verapamil, starting at 240 mg daily and increasing by 80 mg every 2 weeks with a check electrocardiogram (EKG), until the CH was suppressed, side effects intervened, or to a maximum daily dose of 960 mg. One patient had 1,200 mg/day. Eighty-nine patients (41%) had no EKGs. One hundred eight had EKGs in the hospital notes, and a further 20 had EKGs done elsewhere. Twenty-one of 108 patients (19%) had arrhythmias. Thirteen (12%) had first-degree heart block (PR > 0.2 s), at 240 to 960 mg/day, with one requiring a permanent pacemaker. Four patients had junctional rhythm, and one had second-degree heart block. Four patients had right bundle branch block. There was bradycardia (HR < 60 bpm) in 39 patients (36%), but verapamil was stopped in only 4 patients. In eight patients the PR interval was lengthened, but not to >0.2 s. The incidence of arrhythmias on verapamil in this patient group is 19%, and bradycardia 36%. CONCLUSION: We therefore strongly recommend EKG monitoring in all patients with cluster headache on verapamil, to observe for the potential development of atrioventricular block and symptomatic bradycardia.

PMID: 17698788 [PubMed]

« Reply #7 on: Today at 1:01am » WITH THANKS TO "MJ" FOR POSTING THIS EXPLANATION. 

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The article summarized in layman terms from the website below.

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"Cluster Headache Treatment Poses Cardiac Dangers 
Off-label use of verapamil linked to heart rhythm abnormalities, study finds 

By Jeffrey Perkel
HealthDay Reporter   

MONDAY, Aug. 13 (HealthDay News) -- People who use a blood pressure drug called verapamil to treat cluster headaches may be putting their hearts at risk.

That's the finding from a British study that found heart rhythm abnormalities showing up in about one in five patients who took the drug in this unapproved, "off-label" way.

"The good news is, when you stop the drug, the effect wears off," said study lead author Dr. Peter Goadsby, professor of neurology at University College London. "So, as long as doctors know about it, and patients with cluster headaches on verapamil know they need EKGs [electrocardiograms] done, it is a completely preventable problem." 

The study is published in the Aug. 14 issue of Neurology.

In a review of the medical records of 217 patients given verapamil to treat their cluster headaches, a team led by Goadsby found that 128 had undergone an EKG, 108 of which were available in the medical records.

Of those 108 patients, about one in five exhibited abnormalities (mostly slowing) in the heart's conduction system -- the "natural pacemaker" that causes the organ to beat. Most of these cases weren't deemed serious, although one patient did end up having a pacemaker implanted to help correct the problem. In four cases, doctors took patients off verapamil due to their EKG findings.

One in three (34 percent) developed non-cardiac side effects such as lethargy and constipation. 

"It is a very nice piece of work, because it provides commentary on a boutique [that is, niche and off-label] use of the drug," said Dr. Domenic Sica, professor of medicine and pharmacology in the Virginia Commonwealth University Health System. He was not involved in the study.

Cluster headache affects about 69 in every 100,000 people, according to the Worldwide Cluster Headache Support Group Web site. Men are six times more likely than women to be afflicted, and the typical age of onset is around 30. According to Goadsby, the disease manifests as bouts of very severe pain, one or many times per day, for months at a time, usually followed by a period of remission. 

Verapamil, a calcium-channel antagonist drug, is approved by the U.S. Food and Drug Administration for the treatment of cardiac arrhythmias and high blood pressure. The medicine is typically given in doses of 180 to 240 milligrams per day to help ease hypertension. 

However, the patients in this study received more than twice that dose for the off-label treatment of their cluster headaches -- 512 milligrams per day on average, and one patient elected to take 1,200 milligrams per day. The treatment protocol involved ramping up the dose from 240 milligrams to as high as 960 milligrams per day, in 80 milligram increments every two weeks, based on EKG findings, side effects, and symptomatic relief. 

Many patients may not be getting those kinds of tests to monitor heart function, however: In this study cohort, about 40 percent of patients never got an EKG. 

Given the typical dosage, Sica said he was surprised so many patients were able to tolerate such high amounts of the drug.

"When used in clinical practice for hypertension, the high-end dose is 480 milligrams," said Sica. "Most people cannot tolerate 480."

Dr. Carl Pepine, chief of cardiology at the University of Florida, Gainesville, was also "amazed" at the doses that were tolerated in this study. "The highest dose I ever gave [for cardiology indications] was 680 milligrams. This might give me more encouragement to use the drug at higher dose," he said. 

But Sica said he thought cardiac patients -- the typical verapamil users -- were unlikely to tolerate the drug as well as the patients in this study, because verapamil reacts differently in older individuals, who are more likely to have high blood pressure, than in younger patients. The average patient in the United Kingdom study was 44 years old. 

According to Sica, two factors would conspire to make older individuals more sensitive to verapamil. First, the metabolism of the drug is age-dependent, meaning that older individuals would tend to have higher blood levels of the drug, because it is cleared more slowly than in younger individuals.

Secondly, the conduction system of the heart (the natural "pacemaker" becomes more sensitive to the effects of verapamil with age, Sica said. 

"It's likely that an older population would not be able to tolerate the same dose," he concluded. 

According to Goadsby, the take-home message of this study is simple: Be sure to get regular EKGs if you are taking verapamil for cluster headaches. Goadsby recommended EKGs within two weeks of changing doses, and because problems can arise over time -- even if the dose doesn't change -- to get an EKG every six months while on a constant dose. 

"The tests are not expensive, and they are not invasive," he said. "They are not in any way a danger to the patient."

For the most part, Goadsby said, should a cardiac problem arise, it will typically go away once the treatment is halted." 





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