After talking to my doctor about the Sumatriptan that I'm taking (the nasal spray) and how it takes too long to be very effective with my relatively short attacks, he prescribed START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE as a prophylactic. My blood pressure is fine, I'm strong and healthy and engage actively in several combat sports, so I'm not so keen on screwing with my blood pressure too much. Has anyone got some experience with Verapamil while still having a fine blood pressure? What can I expect, and how likely is it that it's going to work?

Thanks!

For a good many folks Verap is not an especailly potent med for lowering BP, i.e., it's a mainline preventive med for CH without significant side effects for most people. Mild constipation for some, especially with the high doses we use, but that's easily controlled.
------
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).

Having been on it for a while now, I have concluded that, unfortunately, this does absolutely nothing for me except give me bouts of dizziness when I excercise. :(

How much are you taking?  Most people don't find relief till they are on a fairly high dose.  It also takes a while to build up in your system.  Some say two weeks, the Neuro that diagnosed my CH said as much as a month.   The side effects disappear for most people after having been on it a while.  It makes me very tired but, after a couple of weeks, it is more tolerable.    I'd rather be tired from the Verap than from night time hits.

Hope you're pf soon!

Jeannie

I'm taking 240mg a day. I'll talk to the doctor about upping the dosage.

DV8,

I take 720 extended release Verap. daily.  It has had very little effect on my blood pressure, which is normal.  I also play sports several times a week and it has had no effect there as well.  The only adverse effect the I have noticed is my memory.  I used to have one.  Hope this helps.  

Regards,

Malcom

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.

Thanks for all the helpful information on Verapamil.  The prescription I have reads VERAPAMIL 240 MG TABLET SA.....would the SA stand for short acting?  I have been on 480 mg now for about 10 days (started out with 240 mg for one week then increased to 480 mg) and enjoyed a 9 day run without an attack!  I have had 2 attacks in the last 5 days and have increased my dosage to 720 mg (in 24 hours).  I go to the neurologist again on the 8th.  Wondering about the 80 mg dose as a smaller increment.  

Thanks Again,
Cindy

Verap. may take 1-3 weeks to take effect and then the possibility of dosage changes. Patience!

Private Aye wrote on Oct 2^nd, 2008 at 4:39pm:

Thanks for all the helpful information on Verapamil.  The prescription I have reads VERAPAMIL 240 MG TABLET SA.....would the SA stand for short acting?  I have been on 480 mg now for about 10 days (started out with 240 mg for one week then increased to 480 mg) and enjoyed a 9 day run without an attack!  I have had 2 attacks in the last 5 days and have increased my dosage to 720 mg (in 24 hours).  I go to the neurologist again on the 8th.  Wondering about the 80 mg dose as a smaller increment.   Thanks Again, Cindy

Hi Cindy,

PLEASE tell us you are NOT increasing dosage without consulting your doc. NOT a good idea!!!

Are you sure it doesn't say "SR" or it's not a typo. What you describe sounds like "SR" to me.

I use 480mg/dy of regular verap (720 mg in high cycle). It is a wonderful med. The SR version does NOT work (for me).

Oh, and lissen to Bob, he knows what he's talkin' 'bout.

Best,

Jon

Hi Jon-

After reading the two options for verapamil re; slow release, regular release, etc. I went to my pharmacist to find out which one I was prescribed.  He said slow release and it does say SA, no typo.  My neurologist was not available when I phoned today.  Earlier this week I did consult with him to add the other 240 mg.  He said to take one tablet every 8 hrs.  I am going in to see him next week and wanted to be able to talk intelligently about the regular release 80 mg tablets that many of you have taken and have experienced better results.  

I think this place is wonderful!

Bob, I know I don't know you but do you remember the old poster with the Buzzard sitting on the Limb staring down the into the Valley  (circa 1970's)?

The caption went something like.........
"Patience my $%#!!  I'm going to Kil Something"

I'm there.

Cindy

ps   :D