In my posts about cluster headache medication and part 3 of my headache story, I briefly mentioned sumatriptan injections (brand names imigran and in Belgium imitrex). In this post I will explain further how this is a miraculous treatment of excruciating cluster headache attacks for a lot of sufferers.
Imigran: miracle drug
After my first imigran injection I was very impressed that pain as debilitating as cluster headache could melt like snow in less than five minutes. I was a bit hesitant to stab myself in the beginning, but now there is no doubt to jab whatsoever. I just press the pen down on my lower left arm and push the button. Furthermore, I no longer isolate myself to jab, I just roll up my sleeve, prepare the injection pen and press the needle in my arm.
Imigran is used as an injection under the skin, the moment the liquid exits the needle, there is a bit of pressure on the point of entrance in the skin, but that is in no way comparable to what the headache attack feels like. After injecting there are some side effects: tingling fingers, heavy arms and legs and, at least for me, a washed-out feeling. This is annoying, but everything is better than having to sit through an attack.
As I’ve mentioned before, sumatriptan (the active ingredient of imigran) causes a shock effect in the body in that it narrows the blood vessels, including blood vessels that might be pushing against a nerve somewhere behind the eye. There is speculation that the pain is caused by this, but why the blood vessels suddenly swell is unknown. The person to figure this out will be a hero amongst cluster headache sufferers.
There is a downside however. You can only use imigran twice per 24 hours. For patients like myself, who have up to 6 attacks, or worse, this isn’t enough. Luckily there are other possibilities to abort attacks. Primarily pure oxygen at a rate of 12 to 15 liter per minute. That can do the trick in about 20 minutes. If it doesn’t work, you can inject imigran.
Using two imigran injections a couple of days in a row is very demanding (at least for me). The attacks themselves drain your energy and I have the impression that using imigran frequently adds to that effect and on top of that: during really bad episodes I use codeine in case oxygen doesn’t work and I’m at my maximum dose of imigran. Codeine makes you very, very drowsy.
Price in Belgium
You might think that using imigran twice a day should be sufficient for most patients. That may be true, but imigran is very expensive. Social security in Belgium is very good. You get sick and the community pays the majority of your healthcare. Most medications are paid for by the state mandated health insurance (which is part of our social security system) for every citizen. When you need medication or care, you only have to pay a small fee of the total price. There is however medication for which this isn’t the case and the decision to have the health insurance pay for it is made on a case by case basis. For imigran the procedure is as follows: A sufferer is entitled to 7 packages of imigran per month at the reduced price (about 9 euro per package). Your neurologist needs to fill out a form and include medical records to prove you need imigran every month to be able to get the reduced price for 7 packages of imigran. If you need more, bad luck, the price for a package is then about 50 euro!
Let’s think about that for a minute: Say a sufferer’s cluster lasts 4 weeks with more than two or more attacks a day. The first 7 days he can get imigran at the reduced rate and be fine (about 9 euro for a package of two injections). The rest of those 4 weeks are very expensive, if he wants imigran for the rest of the cluster he’ll have to fork over more than 1.000 euro to get him through the month. This is only the cost of imigran, this doesn’t include visits to the GP or neurologist and other medication. Chronic patients are worse off, they need imigran every day of the year.
To work around this limitation, I advise to always get the monthly imigran allowance, event though it’s not needed. That way there’s a stock of imigran injections for the bad times.
The system of only 7 packages per month is currently under review in Belgium, and in the future it might get better for cluster headache patients. When this becomes a reality, I’ll report about it on the blog.
As always feel free to share this post with the buttons below. And I’m also curious how the imigran situation is in your country. Is it easily available at a reasonable price? Don’t be afraid to leave a comment!