I have a question about the imigran I'm taking. I was using the nasal spray in the 20mg but I found them to be ineffective almost half of the time, as in 2 hours later there was still no relief. I figured maybe in my haste I was not always using them correctly. So at my last doctors appointment I asked to be prescribed the tablets instead ( I can't get that wrong can I !) I was given imigran in the 50mg. Last night I had to use them and once again there was no sign of relief. After doing a lot more reading today I am now thinking that perhaps my dose was just not high enough  ( in the cases where the spray did not work)  So, my question is, am I not taking enough and if so, do I just keep taking more until I have relief? (within reason of course!) Also, am I taking a step back in the strength of the imigran by going from the 20 nasal spray to one 50 tablet?
Thank you in advance for your guidance.

Pill form is too slow acting to help most Cluster attacks. (The elevated dose, compared to spray, reflects the fact that the effective dose is reduced, to some degree, by the stomach route.)

Technique with the spray is very important but, because of the rapid onset of a Cluster attack, the injection route is the favored form with our folks.

If cost of injection is an issue, discuss the following med with your doc. On a per dose cost basis it's much less than Imitrex and it's almost as fast acting.
====
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.

PMID 11576207 PubMed

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


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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Since this abstract was first posted Zyprexa has appeared in some lists of recommended meds for CH. [BJ]

Using an abortive when an attack is fully developed is far less effective than taking it at the first sign of the attack. Especially the pill will be less useful since it takes longer to become effective than the injection/nasal routes.

If you have such long attacks, talk to your doc about one of the other triptans to abort attacks. The meds in this class vary in duration of effectivness (a quality which has special merit for migraine). Sumatriptan, for examples, has rapid onset and strong initial punch--qualities well suited for Cluster. Others have a "softer" start but with longer effective life.

With sumatriptan, you may experience some initial relief but, since your attacks are of long duration, it begins to lose effectiveness before the headache ends.
----
Because Cluster is so uncommonly seen by docs and their training so limited re. headaches, your experience is too common. IF you have a doc with an receptive ego, you can offer him solid MEDICAL literature to help him learn to help you: many of us have gone this route.

Print the PDF file, below. He will recognize the authority of the source.

And on Oxygen:
Headache. 2010 Nov 16.  [Epub ahead of print]

Inhaled Oxygen and Cluster Headache Sufferers in the United States: Use, Efficacy and Economics: Results From the United States Cluster Headache Survey.
Rozen TD, Fishman RS.

From the Geisinger Wyoming Valley, Department of Neurology, Wilkes-Barre, PA, USA (T.D. Rozen); Linde Healthcare, The Linde Group, Munich, Germany (R. S. Fishman).

Abstract
Objective.- To present results from the United States Cluster Headache Survey concerning the use of inhaled oxygen as acute treatment for cluster headache (CH). Background.- Several small clinic and community-based investigations have indicated that more than 50% of CH patients have never used oxygen for the treatment of their headaches. This statistic is alarming and the reasons why they have not tried oxygen have not been determined. Methods.- The United States Cluster Headache Survey is the largest study ever completed looking at CH sufferers living in the United States. The total survey consisted of 187 multiple choice questions, 84 questions dealt with oxygen use, efficacy and economics. The survey was placed on a website from October to December 2008. Results.- A total of 1134 individuals completed the survey (816 male, 318 female). Among them 868 patients had episodic CH while 266 had chronic CH. Ninety-three percent of survey responders were aware of oxygen as a CH therapy; however, 34% had never tried oxygen. Forty-four percent of patients had to suggest oxygen to their physicians to get prescribed. Twelve percent of physicians refused to prescribe oxygen. Fifty percent using oxygen never received training on proper use. Forty-five percent had to find their own source for oxygen. On prescriptions only 45% specified flow rate, 50% stated CH as diagnosis and 28% indicated mask type. Seventy percent of the surveyed population felt oxygen was effective but only 25% was presently using oxygen. Potential reasons for this finding include: oxygen is slow to onset; prescribed oxygen flow rates are too low for efficacy and most CH patients need to raise flow rates during attacks to achieve response. The efficacy of oxygen does not vary by the age of the patient, gender, the number of CH attacks per day, and smoking history. Episodic CH responds better and faster to inhaled oxygen than chronic CH. Oxygen plus a triptan may be more efficacious and faster at aborting a CH than a triptan alone. Sixteen percent of CH patients state that oxygen is unaffordable while 12% are getting welder grade oxygen because of costs of medical grade oxygen, and this form of oxygen could be potentially dangerous to the individual user. Conclusions.- Oxygen is underutilized by CH patients living in the United States. Current recommended oxygen treatment regime is not meeting the needs of many CH patients. Prescribed oxygen flow rates are too low for efficacy. Oxygen can be expensive and very difficult to obtain. Physicians need to be better educated on the use of inhaled oxygen for CH.

© 2010 American Headache Society.
PMID: 21083557 [PubMed

you must give your doc his own headache by arming ur self with the facts as i was only able to do with the help of this and the ouch website members! .....
good luck . ben

Awesome job Ben, and great advice. We must be our own strongest advocates!

Joe

Good work Ben, it's just crazy that you had to go through that process to get the treatment you need. How many others are still suffering because of doctors like that?

You indicated that oxygen doesn't always work. How exactly are you using it?

Have you read the oxygen info on the left?

G'day Hayley, and welcome. Just out of interest, is Imigran all you're using to fight off this beast? As an abortive it's very good but there's lots of other stuff available too, and not just to hit an actual attack but hopefully to stop them beforehand.

A lot of people have great success with preventatives prescribed by doctors and even some over-the-counter stuff like melatonin and Red Bull.

Oxygen of course is pushed by many and the outcomes are just terrific. It's not difficult to arrange and our good friend Mad Barry of Karratha will give you all the good gen. (He just spends a lot of time out bush, he says, but the rumours are better).

Either way, you're amongst friends now and it's my first shout.

Cheers from the north,

B.

Great news. It's amazing how once someone has learnt just what a difference oxygen can make that all they want to do is to tell others and get them to try it.

My wife found the original streaming board for me many years ago or I'd still be chewing aspirin and suffering! That's great news on the oxygen, we couldn't be happier for you.

Joe

mrben1230 wrote on Mar 19^th, 2012 at 7:16pm:


Wise this man is, the force is strong in this one.

Joe