WOW - that ER really slammed you - ideas in msg

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Posted by gary ( on December 31, 1999 at 11:27:05:

In Reply to: A little visit to the ER this morning.... (oh, joy...) posted by Terri on December 30, 1999 at 21:06:17:

2 different treatment programs usually attempted:

1. prophylactic =
attempts to stop the entire cluster cycle or prevent attacks from even starting within a cluster

2. abortive=
attempts to stop or reduce the pain of the individual attack once it starts

seems like there is NO consistently reliable prophylactic that completely stops the cycle or completely prevents the attacks/ lots of ppeople trying lots of things - very tough to ACCURATELY guage the results because the CH itself is so variable, even within an individual
there ARE patterns whoich show up over time, but they are very loose, and prone to change anyway, so tricky to decide "what's live and what's medicinex"

re: abortives- there ARE a few which nearly everybody finds helpful:

imitrex injections (see imitrex tip button at left of screen)

high flow (8 liters/minute) pure oxygen, thru a NONrebreather mask, must start at very first sign of attack, usually "beats it" in 10-20 minutes, stay on it til attack is fully cleared,but DON'T use it for long periods or to attempt to "prevent" attacks - overuse is risky

cafergot (generic = ercaf) a relatively cheap alternative , works for most - BUT must take the pill IMMEDIATELY at first sign of attack, or it doesn't work in time to really help PLUS there are bad side effects of used too often/too long
a good occasional answer though

sometimes big doses of simple antihistamine (like diphenhydramine - generic benadryl)can reduce or suppress an attack - again, IF taken at first sign
of attack - I often rely on this early in each cluster, until I see if it's going to develop fully, requiring the heavier duty stuff

personally don't like the sound of using prednisone for these -
horrible side effects, often longtime delayed,
can't wisely use for sustained prevention and there are better, safer alternatives (above) for attack suppression

strong painkillers (percoset,oxycodone,hydrocodone etc)
some people claim they don't work in CH - I disagree, BUT I have found they are like the others - you have to get it in immediately or the attack "beats it", PLUS we VERY rapidly build a tolerance, which requires higher doses, and then there are all kinds of problems -
best suggestion might be: "only as a last resort, and only once in a while"

good luck !

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