Posts Tagged ‘triptans’
March 4, 2012 | 
Author Refractory headache basically is “what to do for difficult, frequent headaches when things have not easily worked”. I started the Refractory Headache Section of the American Headache Society 11 years ago; we have spent a decade defining refractory headache(my new article, a 10 year study on refractory headaches using a unique refractory scale, is on homepage here on this site, and is open access on The Journal of Headache and Pain).
There are many subsets to the topic of refractory headaches: refractory to preventives and refractory to abortives…..adolescent refractory headaches….refractory in older folks(after age 65, for instance)….pathophysiology(or, what is going on in the nervous system in refractory patients..including neuroimaging, such as fMRI and DTI)….Treatment, both inpt. and outpt(I have published extensively on these options, some of which is on this site…opioids/MAOI’s/Botox/Stimulants/Daily Triptans)……and the role of medication overuse. Medication overuse must be distinguished from Medication Overuse Headache, which is much different..some overuse the meds but do not have rebound, or withdrawal, headache from the drugs/caffeine overuse. More on this later on…
For comments, doclarryrobbins@aol.com
Refractory means “difficult to treat”…where the headaches have not responded to the usual minstrations..this is a common situation. Previously, I had published several studies(in our Archives) on long-term effects of daily headache preventives: bottom line is, only about 46% of headache patients have “long-term” success from the preventives(such as antidepressants/beta blockers/anticonvulsants, etc.). From months 6 to 15, after starting preventives, many people stop them because of declining efficacy and/or side effects.
So, what happens to these(3 million in the US) people with chronic daily headaches and no effective treatment?….I started the section of the American Headache Society 11 years ago on The Refractory Headache Patient. I have published on this(see articles on our homepage)….some of the medication approaches I employ include: long-acting opioids, frequent triptans, stimulants, MAOI’s, and Botox. However, for some nothing really works: we desperately need better and newer headache(and pain) preventives.
Posted in headachedrugs | 
Tags: botox, chronic migraine, refractory headache, stimulants, triptans | 
No Comments »
The main abortives for clusters remain:
- triptans (Imitrex, Maxalt, etc.),
- oxygen
- analgesics
- lidocaine nasal spray
- ergots.
Triptans do work the best, particularly Imitrex injections (many cluster sufferers get by with 2 or 3mg, which is half of a vial). Oxygen, 100% at 7 to 10l/min, works for about 60% of pts. Analgesics can take the edge off, but do not stop the headache. Lidocaine is very mildly, if at all, effective, but may be helpful while awaiting something else to work. Ergots are not used much anymore, but can be very helpful, albeit with more side effects.
Posted in Uncategorized | Tags: cluster, cluster headache, ergots, Headache, Imitrex, lidocaine, oxygen, triptans | No Comments »
Several new triptans (Imitrex-type meds) have come on the market in the past year and a half; Axert (almotriptan) came out 1.5 years ago, and more recently Frova. There are pluses and minuses to each.
Axert is relatively mild, with very few chest symptoms; it is well tolerated, but does not always pack the impact (work as well) as Imitrex. Frova is longer-lasting, with a half-life of 26 hours, which can be both good and bad. I will explain more about Frova later. Frova is mild, takes longer (up to 2 hours) to work, and is good for longer-developing, slower onset, more moderate migraines.
Posted in headachedrugs | Tags: Axert, Frova, Headache, headache medications, Imitrex, triptans | No Comments »
