Hi,
I've visited this site a few times in the past & have finally decided to sign up!
I'm currently getting CH after 3 years without them. I consider myself "lucky" this time round as they are only lasting between 15-30 minutes. I get the odd one through the day but 2 or 3 during the night. They've been going since September.
Anyway just a quick question. I've been prescribed Verapamil for the first time & they dont seem to be working. I've only been taking them for a week & the dosage is 80mg per day. Is this about the right dosage & do they take time to work?
Any help would be much appreciated.
Tony.

80 mg is a very low dose, you should speak to your Doctor about upping the dose.  Many here are on 360mg-480mg per day or Higher!

Hi Tony and welcome. I am a Verap user myself and I found it takes 2 to 3 weeks for it to get into your system. 8o mg daily probably wont do anything for CH's, as this is such a lose dose.
It took some fine tuning but with the approval of my neuro, I take 480 mg daily of Verap and that seems to me my magic dose. Seems to keep the majority of hits to a minimal, and I have oxygen with a 25 LPM regulator and an o2ptimasx which aborts the one's that get through.
Do you have o2? Read all the info to your left, there are some leaps and bounds in dealing with the beast.

  Barry :)

720 mg a day here.

I'm right there with Barry. And I think my neuro may up it on my next appointment because his attitude is that a 80% reduction in normal or migraine headaches is game over, go home and celebrate...but with CH's, even one a day is one a day too many. Still...I'm celebrating the one a day over 6 a day any day. Blessings, and welcome. lance

This is a widely used protocol for use of Verap. Suggest you print it out and give to your doc.
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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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SLOW-RELEASE VERAPAMIL

Dr. Sheftell applauded the protocol for verapamil used by Dr. Goadsby and colleagues, which entailed use of short-acting verapamil in increments of 80 mg. “This method was suggested by Lee Kudrow, MD, 20 years ago as an alternative to slow-release verapamil,” Dr. Sheftell noted.

“I would agree with using short-acting verapamil, rather than the sustained-release formulation, in cluster headache,” he said. “I prefer the short-acting formulation with regard to ability to titrate more accurately and safely. My clinical experience anecdotally demonstrates improved responses when patients are switched from sustained-release verapamil to short-acting verapamil.”

Dr. Goadsby agreed that his clinical experience was similar. “There are no well-controlled, placebo-controlled, dose-ranging studies to direct treatment. This is one of those areas where clinicians who treat cluster headache have to combine what modicum of evidence is available with their own clinical experience,” Dr. Sheftell commented.

Hi Bob. I'm on to it! I see my doc this morning.
Thanks for your time & trouble.
Tony.