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Antidepressant withdraw and CHs (Read 2407 times)
Luna
Ex Member



Antidepressant withdraw and CHs
Feb 17th, 2012 at 9:15pm
 
Hello all,
This is my first post as I am a new member. I have had CH for 15 years. I thought that I grew out of them because I was CH free for about 4 years  Grin. However, I am now in the middle of a awful cycle  Cry The only connection I can make is that right before the start of my cycle I weened off of celexa which I had been taking for 3 of the 4 years that I didn't have CHs. Is this a coincidence? It can't be that easy, right? Anyway, been a brutal cycle as of resent and I can't wait to see its end. Also, anyone take cardizem instead of verapamil? That's what I was put on (By a PCP) along with a second round of prednisone and imitrex injections.
Let me know if you have any insight.
Thanks!
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« Last Edit: Feb 18th, 2012 at 12:54am by N/A »  
 
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Bob Johnson
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Re: Antidepressant withdraw and CHs
Reply #1 - Feb 18th, 2012 at 9:07am
 
First, some homework:
Please tell us where you live. Follow the next line to a message which explains why knowing your location and your medical history will help us to help you.

Cluster Headache Help and Support › Getting to Know Ya › Newbies, Help us...help you

You can add your location by editing your profile. CP Member --> profile
BUT, Please!, don't post your messages at this location. They won't get the attention you want: use the appropriate sections which follow.
==============

Seriously doubt that stopping the Celexa is related to the Cluster. At best, anti-de. have been used to ease the pain in some pain disorders but they are not primary treatments for Cluster.

Cardizem is an old med fo migraine. A search of the medical literature didn't disclose anything after 1986 re. its use in Cluster. (I'm guessing your PCP is not up to date re. Cluster--a very common experience with folks here. If you want to stay with him, print out the PDF file, below, and give to him--you study it too!)

Verapamil is th first-choice for long term prevention. Following is a widely used protocol. Print and give to your doc.
---
Headache. 2004 Nov;44(10):1013-8.   

Individualizing treatment with verapamil for cluster headache patients.

Blau JN, Engel HO.


    Background.-Verapamil is currently the best available prophylactic drug for patients experiencing cluster headaches (CHs). Published papers usually state 240 to 480 mg taken in three divided doses give good results, ranging from 50% to 80%; others mention higher doses-720, even 1200 mg per day. In clinical practice we found we needed to adapt dosage to individual's time of attacks, in particular giving higher doses before going to bed to suppress severe nocturnal episodes. A few only required 120 mg daily. We therefore evolved a scheme for steady and progressive drug increase until satisfactory control had been achieved. Objective.-To find the minimum dose of verapamil required to prevent episodic and chronic cluster headaches by supervising each individual and adjusting the dosage accordingly. Methods.-Consecutive patients with episodic or chronic CH (satisfying International Headache Society (IHS) criteria) were started on verapamil 40 mg in the morning, 80 mg early afternoon, and 80 mg before going to bed. Patients kept a diary of all attacks, recording times of onset, duration, and severity. They were advised, verbally and in writing, to add 40 mg verapamil on alternate days, depending on their attack timing: with nocturnal episodes the first increase was the evening dose and next the afternoon one; when attacks occurred on or soon after waking, we advised setting an alarm clock 2 hours before the usual waking time and then taking the medication. Patients were followed-up at weekly intervals until attacks were controlled. They were also reviewed when a cluster period had ended, and advised to continue on the same dose for a further 2 weeks before starting systematic reduction. Chronic cluster patients were reviewed as often as necessary. Results.-Seventy consecutive patients, 52 with episodic CH during cluster periods and 18 with chronic CH, were all treated with verapamil as above. Complete relief from headaches was obtained in 49 (94%) of 52 with episodic, and 10 (55%) of 18 with chronic CH; the majority needed 200 to 480 mg, but 9 in the episodic, and 3 in the chronic group, needed 520 to 960 mg for control. Ten, 2 in the episodic and 8 in the chronic group, with incomplete relief, required additional therapy-lithium, sumatriptan, or sodium valproate. One patient withdrew because verapamil made her too tired, another developed Stevens-Johnson syndrome, and the drug was withdrawn. Conclusions.-Providing the dosage for each individual is adequate, preventing CH with verapamil is highly effective, taken three (occasionally with higher doses, four) times a day. In the majority (94%) with episodic CH steady dose increase under supervision, totally suppressed attacks. However in the chronic variety only 55% were completely relieved, 69% men, but only 20% women. In both groups, for those with partial attack suppression, additional prophylactic drugs or acute treatment was necessary. (Headache 2004;44:1013-1018).

=======================================
SLOW-RELEASE VERAPAMIL

Dr. Sheftell applauded the protocol for verapamil used by Dr. Goadsby and colleagues, which entailed use of short-acting verapamil in increments of 80 mg. “This method was suggested by Lee Kudrow, MD, 20 years ago as an alternative to slow-release verapamil,” Dr. Sheftell noted.

“I would agree with using short-acting verapamil, rather than the sustained-release formulation, in cluster headache,” he said. “I prefer the short-acting formulation with regard to ability to titrate more accurately and safely. My clinical experience anecdotally demonstrates improved responses when patients are switched from sustained-release verapamil to short-acting verapamil.”

Dr. Goadsby agreed that his clinical experience was similar. “There are no well-controlled, placebo-controlled, dose-ranging studies to direct treatment. This is one of those areas where clinicians who treat cluster headache have to combine what modicum of evidence is available with their own clinical experience,” Dr. Sheftell commented.
====
With a lenghty break since you last Cluster cycle, you might find it useful to read this article.




Cluster headache.
From: Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register (Orphanet Journal of Rare Diseases)
[Easy to read; one of the better overview articles I've seen. Suggest printing the full length article--link, line above--if you are serious about keeping a good medical library on the subject.]

Leroux E, Ducros A.

ABSTRACT: Cluster headache (CH) is a primary headache disease characterized by recurrent short-lasting attacks (15 to 180 minutes) of excruciating unilateral periorbital pain accompanied by ipsilateral autonomic signs (lacrimation, nasal congestion, ptosis, miosis, lid edema, redness of the eye). It affects young adults, predominantly males. Prevalence is estimated at 0.5-1.0/1,000. CH has a circannual and circadian periodicity, attacks being clustered (hence the name) in bouts that can occur during specific months of the year. ALCOHOL IS THE ONLY DIETARY TRIGGER OF CH, STRONG ODORS (MAINLY SOLVENTS AND CIGARETTE SMOKE) AND NAPPING MAY ALSO TRIGGER CH ATTACKS. During bouts, attacks may happen at precise hours, especially during the night. During the attacks, patients tend to be restless. CH may be episodic or chronic, depending on the presence of remission periods. CH IS ASSOCIATED WITH TRIGEMINOVASCULAR ACTIVATION AND NEUROENDOCRINE AND VEGETATIVE DISTURBANCES, HOWEVER, THE PRECISE CAUSATIVE MECHANISMS REMAIN UNKNOWN. Involvement of the hypothalamus (a structure regulating endocrine function and sleep-wake rhythms) has been confirmed, explaining, at least in part, the cyclic aspects of CH. The disease is familial in about 10% of cases. Genetic factors play a role in CH susceptibility, and a causative role has been suggested for the hypocretin receptor gene. Diagnosis is clinical. Differential diagnoses include other primary headache diseases such as migraine, paroxysmal hemicrania and SUNCT syndrome. At present, there is no curative treatment. There are efficient treatments to shorten the painful attacks (acute treatments) and to reduce the number of daily attacks (prophylactic treatments). Acute treatment is based on subcutaneous administration of sumatriptan and high-flow oxygen. Verapamil, lithium, methysergide, prednisone, greater occipital nerve blocks and topiramate may be used for prophylaxis. In refractory cases, deep-brain stimulation of the hypothalamus and greater occipital nerve stimulators have been tried in experimental settings.THE DISEASE COURSE OVER A LIFETIME IS UNPREDICTABLE. Some patients have only one period of attacks, while in others the disease evolves from episodic to chronic form.

PMID: 18651939 [PubMed]
====
Overall, we suggest working with a headache specialist, if at all possible. Most doc, even neurologists, receive meager education in headache.
--
LOCATING HEADACHE SPECIALIST

1. Search the OUCH site (button on left) for a list of recommended M.D.s.


2. Yellow Pages phone book: look for "Headache Clinics" in the M.D. section and look under "neurologist" where some docs will list speciality areas of practice.

3.  Call your hospital/medical center. They often have an office to assist in finding a physician. You may have to ask for the social worker/patient advocate.

4. Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register; On-line screen to find a physician.

5. Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register Look for "Physician Finder" search box. They will send a list of M.D.s for your state.I suggest using this source for several reasons: first, we have read several messages from people who, even seeing neurologists, are unhappy with the quality of care and ATTITUDES they have encountered; second, the clinical director of the Jefferson (Philadelphia) Headache Clinic said, in late 1999, that upwards of 40%+ of U.S. doctors have poor training in treating headache and/or hold attitudes about headache ("hysterical female disorder") which block them from sympathetic and effective work with the patient; third, it's necessary to find a doctor who has experience, skill, and a set of attitudes which give hope of success. This is the best method I know of to find such a physician.

6. Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register NEW certification program for "Headache Medicine" by the United Council for Neurologic Subspecialties, an independent, non-profit, professional medical organization.
        Since this is a new program, the initial listing is limited and so it should be checked each time you have an interest in locating a headache doctor.





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Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register (96 KB | 16 )

Bob Johnson
 
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Guiseppi
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Re: Antidepressant withdraw and CHs
Reply #2 - Feb 18th, 2012 at 9:46am
 
Welcome to the board Luna. Bob's posts are long and technical...read them anyways! Wink He's the guru of research on this board.

You haven't mentioned oxygen. No matter what else you use as a prevent or an abortive, you should have oxygen on hand, I abort my attacks in 6-8 minutes just huffin 02. read this link as it must be used correctly or it doesn't work:

Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register

So glad you found us. Keep reading and soon you'll know more about CH then most doc's you see. Smiley

Joe
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"Somebody had to say it" is usually a piss poor excuse to be mean.
 
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Luna
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Re: Antidepressant withdraw and CHs
Reply #3 - Feb 19th, 2012 at 1:24am
 
Thanks Bob for the credible info! I appreciate you taking the time to do that. My next step is to get into a specialist. Also I will definitely watch where I post from here on out.
Thanks again!
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« Last Edit: Feb 19th, 2012 at 1:25am by N/A »  
 
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Luna
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Re: Antidepressant withdraw and CHs
Reply #4 - Feb 19th, 2012 at 1:35am
 
Guiseppi,
Thank you for your reply. I have used oxygen therapy for a number of years. Unfortunately my current PCP doesn't think it is worth the referral(apparently he thinks insurance will be a no go). It has worked well for me in the past. I have seen some real progress in the last 48 hours.  Cheesy I am down to my last day on my pred taper (this is my second taper this cycle) and have only had 1 minor CH in the last 2 days. This hopeful means there is now some light at the end of the tunnel.
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Billie
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Re: Antidepressant withdraw and CHs
Reply #5 - Feb 19th, 2012 at 5:59am
 
I agree that I don't thing weaning off Celexa would cause your clusters to flare up, but I know that the withdrawal from going off those types of medications probably doesn't help matters.  I tried going off Paxil when I was pregnant, and I got horribly sick.  I now take Cymbalta, and my GP once told me that "it should be helping your headaches."  I honestly wanted to slap him, lol. 

I am having the same problem getting oxygen out of my neuro.  She said insurance usually doesn't cover it unless it's lung related.  I am thinking about doing the welder's oxygen that I've read about on here.
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Guiseppi
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Re: Antidepressant withdraw and CHs
Reply #6 - Feb 19th, 2012 at 9:17am
 
For both of you, don't be afraid to take on the insurance company, and educate them a little bit. When they hear the high flow, they think you'll be going thru oxygen like candy. Once they understand HOW we use it, and compare the "per abort cost: to the imitrex, they're usually much more willing to take it on.

But even without insurance, it's cheap. E-Tanks rent for about $5 a month, $12-$15 per refill, with an initial $50-$100 investment to buy your regulator and mask, you're all set. And yes, welding oxygen is even cheaper.

Joe
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"Somebody had to say it" is usually a piss poor excuse to be mean.
 
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Luna
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Re: Antidepressant withdraw and CHs
Reply #7 - Feb 19th, 2012 at 12:57pm
 
HI Billie,
Sorry you are having similar problems getting o2. My dr. Is only good for one thing, prescribing me pred and imitrex upon request. With regards to the Celexa, I didn't think it was going to be as easy as to just stay on it an no CHs.  It just seemed weird that I hadn't had a cycle while on it for close to 5 years. How long have you been suffering? Cry
Thanks again Guiseppi... I will be better prepared next cycle.
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