A useful article to share with your neurologist.


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).

Welcome to the site Klaus.  Looks like you have things somewhat under control.  Bob Johnson's article above is excellent.  I'm scheduled to talk with my doc soon and I'll probably take that with me.  I got verapamil from my doc initially because my blood pressure was a little high and he didn't see any harm.  Since then, my BP is down thru a diet.  I'm hoping he'll continue the verapamil just for the CHs.

Glad to see you might be out of cycle.  I think I might be too.  I'm 4 nights without a CH.  I get a shadow here and there but I think that just be my mind playing tricks.  Its funny because I just started a HA diary a few days before (cross my fingers) my cycle ended.

Again, welcome!  Lots of good info on this site and the site's links.

Brett

Quote:

My girlfriend learned to live with me and my very own beast, thanks to her for understanding / supporting.

She is worth her weight in gold Klaus.  Tell her I said that.   ;)

Linda

She is worth her weight in gold Klaus.  Tell her I said that.  

Linda

What Linda said. My wife has stuck thru 28 years of these damned things and still hasn't been scared away. Hard to thank our supporters  enough. Glad you found us, welcome in!

Guiseppi

welcome to the family, coach bill

Klaus, sorry you had to find us, but glad you did. As usaual, Bob Johnson is RIGHT on the money, you can get SUCH GREAT info. here. As far as the supporters go, linda and Guiseppi are once AGAIN correct!! My wife has stuck with me for almost 19 years now,( had CH for 23). Thats ALL the more reason to treat her like a princess when we are NOT in cycle.   GOod luck!!!     Tuck