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Topic: Verapamil and CH Research Article (Read 1108 times) |
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maria9
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Verapamil and CH Research Article
« on: Dec 9th, 2004, 9:03am » |
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Hey all,
I came across this article and found it interesting that the researchers suggest taking more verapamil before bedtime if nocturnal CH's are a problem or setting the alarm clock to two hours before waking to take a dose if you have the "wake-up" CH's in the morning. Of course, you would have to check with your doctor about this and EKG's are usually advised when upping verapamil levels. The researchers also report higher levels of success with verapamil than I have seen reported elsewhere.
Marsha 
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;44:1013-101 .
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maria9
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Re: Verapamil and CH Research Article
« Reply #1 on: Dec 12th, 2004, 8:21pm » |
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Just giving this the old bump because I know many of you out there are on verapamil. If you do have the tendency to have the nocturnal headaches (as most of us do) this study suggests that as you are increasing your verapamil dosage, it would behoove you to take the extra dosage before bedtime rather than in the morning or mid-afternoon.
I know, I know, old boring verapamil stuff, but important nonetheless as the majority of us are prescribed this as well as Pred.
Marsha
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Ueli
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Re: Verapamil and CH Research Article
« Reply #2 on: Dec 12th, 2004, 10:51pm » |
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This article seems a bit odd to me, and somewhat contradicting the experiences reported on this board.
Starting with a very low dose (for clusters) of 200 mg/d, and in case of no success increasing by 20 mg per day (it is not said with what delay), is a scheme that only can be concocted by people who have no idea of the severity of cluster pain.
The half-life time of Verapamil in the body is only 6 to 8 hours. Therefore, it seems to make sense to adjust the taking of the pills to the expected attack time. But from many reports on this board we know that a dose change will show only effects with a delay of 7-10 days. This indicates that not the Verapamil itself (with its short half-life) but some of its many metabolites (having a much longer half-life) bring the desired effect.
No mention is made of the sort of Verapamil used, the regular, the slow release (SR) or the delayed release (HS, ER). This is such a crucial point, that it should be told even in an abstract.
Just my 
Ueli 
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maria9
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Posts: 145
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Re: Verapamil and CH Research Article
« Reply #3 on: Dec 12th, 2004, 11:45pm » |
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Thanks, Ueli,
I was not sure of what to make of this study as well. although I did notice one night when I took an extra 120 mg before bedtime - no nocturnal attacks. OK, at that point I was up to 480 mg a day and supplementing with the shroom treatment as well as ducosate sodium (stool softener). So who the hell knows? I wish I did.
Marsha
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