Individualizing Treatment With Verapamil for Cluster Headache Patients
Authors: Joseph N. Blau; Hans O. Engel

Source: Headache: The Journal of Head and Face Pain, Volume 44, Number 10, November 2004 , pp. 1013-1018(6)

Publisher: Blackwell Publishing

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)

I won't do anything about the dosage without consulting the good Dr.

Maybe I can alter the timing of my current dosage though....right now I am taking it in the morning....perhaps I should be taking it in the evening ??

Also, we will be stopping by the health food store later tonight to see if I can procure some kudzu root.... I am already taking Mg 250 mg twice a day; adding kudzu would get me close to the remedy proposed by Kilowatt 3 !!

Yes, I tried the O2 the other night in the middle of my K7-K8 breakthough headache....laid it low in about 15 minutes but I fought shadows the whole rest of the night and most of yesterday.

the medical supply place gave me one E tank (which I can refill to be sure), but I've felt the need to be very careful about how much O2 I am using because of this. I am going to politely insist on at least one more E tank as soon as I need a refill this week.