Bob Johnson
CH.com Alumnus
 
Offline

"Only the educated are free." -Epictetus
Posts: 5965
Kennett Square, PA (USA)
Gender:
|
The general understanding is that any med used to abort or control pain can, with overuse, create rebound attacks. There is no predicting who will be sensitive to what specific med for, with sumatriptan, many folks use high doses without a problem. This is true with OTC pain meds, for example, where the general rule is that odds increase of rebound if you use them 3-5x/wk on a regular basis.
There is no test to know if an attack is a rebound or not for, by definition, a "normal" attack and a rebound are the same type headache re. our experience of them.
Total withdrawal of the suspect med is the response. If # of headaches decline in a few days, the assumption is that you are having some rebound attacks. Choice is to shift to another med. ===== Previously posted material: We tend to use "rebound" a bit too robustly here AND, in the closed context of our chats, it can take on a meaning which is not always consistent with the medical usage/meaning of the word. ===== Rebound headaches. "Rebound Headaches--A Review", Au. John S. Warner, M.D., in HEADACHE QUARTERLY, 10:3(1999). (There is some confusion on the board about the meaning of "rebound". There appears to be an emerging consensus in the medical literature to define "rebound" as a headache which is caused by the overuse of any medication used to abort a headache or relieve pain. "Recurrence" [of a headache] is being used to refer to the redevelopment of an attack when its "normal" duration is longer than the useful life of the medication which has been taken. That is, the medication effectiveness is reducing before the headache has come to an end; the pain redevelops.) ================================================================= Sumatriptan has a hard initial punch and relatively short effective life--a combination which works well for most Cluster attacks. However, some people, whose Clusters have a longer life, find that the med is wearing down even as the pain continues. One can understand how this sequence comes into one's thinking: Attack, Imitrex injection, pain continues, it's a rebound cluster which has developed from the Imitrex. In fact, this is a recurrence of the attack, not a rebound.
This is one of the reasons that several other triptans were developed having less initial punch but longer effective life. While aimed at the migraine crowd, at first, a number of cluster users have found this characteristic of value to them. ======= "Medication-Overuse Seen as Epidemic, First Management Guidelines Issued: Presented at IHC " By Larry Schuster ROME, ITALY -- September 25, 2003 --
The prevalence was highest in respondents who were their 50s, with 5% of women fulfilling the criteria. Thirty five percent overused simple analgesics, 22% ergotics, 12.5% opioids, 2.7% triptans, and 27% overused combinations of drug classes.
|