Hey guys, the posting about verapimil from UK headache boy and the responses got me wondering some things. I just got off prednisone yesterday and started Verapimil today. To start, I had my first real attack today in almost two weeks aside from shadows on and off. Is this the talk of rebound headaches when coming off your "burst" (mine was for 7 days)? Second, I saw a cople posts giving mention of being careful with the taurine while on verapimil. I have been finding the energy drinks to help with the duration, intensity or both. Can I still safely use both verapimil and the energy drinks simultaneously? Am I to understand the verap regulates or "slows" the heart rate while the energy drink ramps it up? Because I can understand how this would compare to a drug user using an upper and a downer at the same time. Common sense says that's probably not a smart idea. So I'm a little discouraged that I can't use my new friend, aptly named Monster. Lastly, I am starting at 80 mg of verap, then 120 mg, then 160. Compared to the posts of others doses, have I not given it enough time to do its business or does this seem low to you (I'm 5'3, approx. 150 lbs). Sorry to put so many questions in one. Didn't think a dozen posts was in order though. Thanks in advance for any thoughts from the board.

In my 2 seconds of experience with the verap & CH it did take 2 weeks for the verap to have any effect on the attacks at all , but then as you have read on my previous post I,m on a very low dose so this may not be at all relevant .

hope it works out for you
Nigel

btw the bit about the energy drinks scared the crap out of me  :(

The idea of a pred taper is to stop the attacks while you ramp up on a preventative medication.  Some lucky few can actually break a cycle with pred.  If you're not part of that club and wait until the taper is done to begin to ramp up you're left with a hole that the beast can slip through.

Hits following a pred taper are common.  I've never done one but from what I've read there is an increase in hits that happens as you complete the taper.

Taurine and Verapamil: like any medications, you need to be aware of interactions and side effects.  It just so happens that Taurine and Verapamil both affect calcium channels which regulate heart rythm.

As you ramp Verapamil up you need to begin to be careful with energy drink comsumption.  In general, most folks can tolerate one a day without any problem.  However, we are all different and you need to listen to what your body and your physician are telling you. 

I personnally found this out by drinking two Rock Stars in one afternoon/evening while on a dosage of 400mg of verapamil.  My heart was doing the two-step for about an hour.  It scared the crap out of me.

As a result, I won't drink any energy drinks once I ramp up beyond 240mg of Verapamil.  It's just better to be safe than sorry. 

Stick with your Oxygen and, if you need it, Triptans.

The good news is that 400mg of verapamil killed 90% of my hits for the two cycles I used it.  So there wasn't much of a need to use anything else.

-Dennis-

One drawback of self-help sites is that they encourage people to play around with changing doses and types of medicines without any knowledge of the effects. Our hospital emergency rooms are filled with serious problems, including deaths, which this mixing  can cause. This problem has become much more serious in my lifetime because of the increasing sophistication and power of modern medications.

What follows has become a common protocol in using Verap. Suggest you print it and give to your doctor and work together in making changes.

Headache. 2004 Nov;44(10):1013-8.   

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;44:1013-1018).

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HERE ARE TWO MAJOR DOCUMENTS WITH RECOMMENDED TREATMENTS FOR CLUSTER HEADACHE, ONE FROM A U.S. PHYSICIAN, THE SECOND FROM EUROPE.
_________________________________________
START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE
Here is a link to read and print and take to your doctor.  It describes preventive, transitional, abortive and surgical treatments for CH. Written by one of the better headache docs in the U.S.  (2002. Rozen)
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Treatment guidelines from Europe

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A. May, M. Leone, J. Áfra, M. Linde, P. S. Sándor, S. Evers, P. J. Goadsby:
EFNS guidelines on the treatment of cluster headache and other
trigeminalautonomic cephalalgias.
European Journal of Neurology. 2006; 13: 1066–1077.

Download free full text:
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(Thanks to "cluster" for link.)

The protocol Bob posted is exactly what I followed.  It  worked very well for me.

-Dennis-

Just wanted to say thanks for all the info. I need to give the verap a little time to do its thing, its only day two. I just got excited to be pf for almost two weeks. I was frustrated to get out the oxygen three times in two days following a good run without the beast. Such is life. My patience or lack thereof is of no consequence to the beast. Little bastard. Thanks again guys. Will keep the info handy for the doc in case my dosage is non-sufficient after the appropriate amount of time and dosage increase.

I think you should:

a) let us know how it's going with the verapamil after day 14, and

b) be thankful whenever you can kill a hit with O₂.

That doesn't mean you shouldn't participate in all sorts of other topics around here in the meantime, however. ;)

Bob Johnson wrote on Dec 16^th, 2009 at 9:05am:

One drawback of self-help sites is that they encourage people to play around with changing doses and types of medicines without any knowledge of the effects. Our hospital emergency rooms are filled with serious problems, including deaths, which this mixing  can cause. This problem has become much more serious in my lifetime because of the increasing sophistication and power of modern medications.

I agree 100% with this and that is why I will refrain from now on with giving out any advice regarding Medication and dosage amounts or any other procedures that might cause anyone any harm.
 
    Barry