Hello Everyone -

I am in the middle of my worst cycle ever. Basically since the beginning of the year and it doesn't seem to stop.  My neurologist wants to put me on Verapamil; however the starting doses he is indicating don't make sense at all, according to what I read in this website.

He is starting me at 80mg daily increasing 40 mg in a 5 day interval to a max of 320 mg. This means that it will take me 35 days to get to that dose!!! For what read most episodic CH sufferers take between 360 mg and 480 mg.

I do not want to have to wait 35 days to see if this works: that means 35 days of torture!!!  I am using zomigtriptan nose spray as an abortive and I just restarted the vitamin D3 regimen.

However, I would like to know what is the starting dosage that you guys use for verapamil, how you  build it up, and how often you get your ECG done.

Thanks,
Rick

I've recently started on verapamil to try to control my migraines which whilst not being CH, the dosing schedule should be equivalent.

I was started on 120mg a day for 2 weeks and then increased it to 240mg a day with a review after 2 weeks to see if we'll bump it to 360mg a day.

When changing a verapamil dosage it typically takes 7-10 days for the level to become effective and you need a few days to see what the effect is, so changing it quicker than every 2 weeks when trying to fine tune the dose will not be effective.

What dose and increment speed is appropriate for you will depend on your medical history.

It is also normal to use a prednisione taper dose at the start of using verapamil to help provide prevention of CH whilst the verapamil builds up.

The standard recommendation for an ECG is around dose changes and every 3-4 months, but again your personal medical history may indicate otherwise.

Your doctor is nuts. Mike is correct saying the doctor should have started you on a prednisone taper at the same time as starting on the verapamil. 80 of verapamil is way, way to low. You need to start at at least 240. Then, if needed, go up from there. Verapamil is a blood pressure med so watch your blood pressure level closely.

For me.... Methylprednisolone IV and  taper and 240 verap for a week... then 360 for a week then 480. Each increase in the chase for efficacy,  Depending on cycle... would titrate between  480 and 1040. Initial ECG then every 6 months to a year.

Minimal side effects except for some light headedness at 1040. I always drank a lot of water and ate a bunch of fiber to keep things moving along..... as this is concrete dust for some.

Best

Jon

I was started on 240 time release twice a day years ago. But I had high blood pressure so I'm sure that was a factor is starting me so high. Verapamil had very little effect on my BP however so I also take Lisinopril to keep it in check.

Could it be that your blood pressure is already low and the Dr is just being cautious?

No, my doctor really didn't even bother to check my BP to begin with. I am in search of a new neuro.

Rick,

Sounds like a good move.

A BP check is the very basic he should do before considering Verapamil.

Peter.

Peter510 wrote on Jul 3^rd, 2016 at 6:24pm:

A BP check is the very basic he should do before considering Verapamil.

Plus regular BP checks since verapamil is designed to reduce BP and we tend to use it at higher doses than are used to control BP. Plus ECGs should be done too.

In the U.S., neurologists have meager training with complex headache disorders. I would not assume your guy is well trained unless you ask him directly--and since it's your well-being, don't be shy.

The dosing he us unsing is way beloe the norm. For Cluster, not uncommon to start around 200-300 and move upward. At highest doses, a routine EKG is importanat but,even if some irregularity appears, reducing the dose is usually sufficient.

Suggest you print the article, below, and use it as a tool for discussion with him. If you are not satisfied with his response, start looking for a Headache Specialist--they have the training we need.

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Same here. I am checking my BP at least twice a day as per my neurologists suggestion...

...at 540mg per day now, trying to get it to work without the mrthylprednisolone,  and it does funny stuff with my BP (diastolic falls down to 65 and then I feel weak as a kitten). But I was fine up to 360...no adverse effects.