Welcome, Guest. Please Login or Register
Clusterheadaches.com
 
Search box updated Dec 3, 2011... Search ch.com with Google!
  HomeHelpSearchLoginRegisterEvent CalendarBirthday List  
 





Page Index Toggle Pages: 1
Send Topic Print
Verapamil Changed HAs ? (Read 1430 times)
JoeKen
CH.com Veteran
***
Offline


Late Life Sufferer.


Posts: 103
x1||England|europe|177|212|
Gender: male
Verapamil Changed HAs ?
Apr 24th, 2009 at 9:58am
 
Hi Folks,
Long time, no visit !!
About 6 months ago the Consultant upped my Verapamil from 120 mg per day to 240 mg in the morning and 120 mg in the evening. It began to affect my cluster HAs as follows (or coincidence ?): -
First the intensity of the HAs (KIP scale) diminished, then the type and location of HAs changed, and now they have changed again.
First change was from classic CH (centred behind the eye but with a vertical pain field running up into behind the forehead and down to the cheek area), to nearly classic migraine (horizontal across the forehead above and behind the eye  -  no eye pain or tearing).
The next change was from this to 'normal' less painful HAs in this same area. All changes took place gradually and imperceptably.
Nothing else has changed, the timing, (mid to late afternoon start), and duration, (until bed time, fading to zero during sleep), and the frequency, (around 2 HAs every 3 days), remains the same.
The net result of all this is that currently I can control, sometimes eliminate, the pain using a couple of doses of a combination of 1 grm paracetamol and 30 mg of codeine. In the last month or 6 weeks I have had cause only once to revert to almotriptan tabs and/or oxygen  -  life is great !!
Is this an unusual response?  -  has anyone else experienced anything similar ?.
At the moment I can honestly claim NOT to suffer from CH for the first time in around 10 years and probably longer (diagnosed around 10 years ago but suffered much longer).
The improvement has been so imperceptible that, hopefully, it may continue even further  -  let's hope. Grin
Thanks for your interest,
JoeKen. Smiley
Back to top
  

Not sure I should be here, but it's as near as I'm going to get to finding out what is the correct name for my condition. Usually KIP 5 or below but last up to 16 hours and always one-sided, behind the eye, usually right but ocassionally left.
 
IP Logged
 
Bob Johnson
CH.com Alumnus
***
Offline


"Only the educated are
free." -Epictetus


Posts: 5965
Kennett Square, PA (USA)
Gender: male
Re: Verapamil Changed HAs ?
Reply #1 - Apr 24th, 2009 at 11:43am
 
If you have not discovered your excellent support group, please make contact: Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register
------------
Adjusting your Verap dose may be a real help. This protocol has wide acceptance and works well.

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).
======
I'm concerned that you are using pain meds rather than one of the standard cluster abortives. Suggest you print out this list and use as a discussion tool with you doc.

HERE ARE TWO MAJOR DOCUMENTS WITH RECOMMENDED TREATMENTS FOR CLUSTER HEADACHE, ONE FROM A U.S. PHYSICIAN, THE SECOND FROM EUROPE.
_________________________________________
Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register
Here is a link to read and print and take to your doctor.  It describes preventive, transitional, abortive and surgical treatments for CH. Written by one of the better headache docs in the U.S.  (2002. Rozen)
================
Treatment guidelines from Europe

------
A. May, M. Leone, J. Áfra, M. Linde, P. S. Sándor, S. Evers, P. J. Goadsby:
EFNS guidelines on the treatment of cluster headache and other
trigeminalautonomic cephalalgias.
European Journal of Neurology. 2006; 13: 1066–1077.

Download free full text:
Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register
(Thanks to "cluster" for link.)


Back to top
  

Bob Johnson
 
IP Logged
 
DennisM1045
CH.com Alumnus
***
Offline


One wave at a time!


Posts: 3437
Haverhill, Massachusetts, USA
Gender: male
Re: Verapamil Changed HAs ?
Reply #2 - Apr 24th, 2009 at 12:35pm
 
I'm glad it is working for you.  I too get great relief from Verapamil. 

It does change the nature of the HA for me and lessens the severity and frequency of attacks.  What breaks through I mop up mostly with Oxygen.

The article on Verapamil Bob posted above made a huge, positive difference in how I treat my CH.  My theraputic level seems to be ~400mg.

-Dennis-
Back to top
  

Where there is life, there is hope.
Where there is Oxygen, you must use proper caution.
So be safe, don't smoke while using O2. Kill the pain and not yourself.
dennism1045 dennism1045 524417261 DennisM1045 DennisM1045  
IP Logged
 
JoeKen
CH.com Veteran
***
Offline


Late Life Sufferer.


Posts: 103
x1||England|europe|177|212|
Gender: male
Re: Verapamil Changed HAs ?
Reply #3 - Apr 24th, 2009 at 5:02pm
 
Hi all again,
Thanks for the replies so far. It is now appraching bed time  -  well past CH onset time  -  and I haven't got a HA (yet) !!. This makes 2 consecutive days without a HA  -  I honestly cannot remember the last time I have had 2 consecutive days free of ANY HA.
Let's hope it continues,
JoeKen. Grin
Back to top
  

Not sure I should be here, but it's as near as I'm going to get to finding out what is the correct name for my condition. Usually KIP 5 or below but last up to 16 hours and always one-sided, behind the eye, usually right but ocassionally left.
 
IP Logged
 
j0hnglist
CH.com Junior
**
Offline


I Love CH.com!


Posts: 40
Re: Verapamil Changed HAs ?
Reply #4 - Apr 29th, 2009 at 7:18pm
 
whats the update?
I just started Verapamil
Back to top
  
 
IP Logged
 
JoeKen
CH.com Veteran
***
Offline


Late Life Sufferer.


Posts: 103
x1||England|europe|177|212|
Gender: male
Re: Verapamil Changed HAs ?
Reply #5 - Apr 30th, 2009 at 3:49am
 
Hi jOhnglist Smiley,
Welcome to the club !!
Update: -
I started off around 10 years ago being diagnosed with EPISODIC CH but this developed into CHRONIC about 3 years ago and has remained so ever since. Since upping the Verapamil the pattern of hits has changed, as described previously and the changes CONTINUE. The site of the pain is slowly changing and is now high on the forehead, just behind the bone, (it seems). The frequency continues to reduce and it is now around 3 or 4 days since I had a headache worthy of the name  -  I had a shadowy one around mid morning yesterday but it never developed and could be ignored. The timing has also changed -  it ALWAYS struck mid afternoon and at worst every day, at best 2 days out of every 3.
Having said all that, when I was episodic the episodes were seasonal, starting around October and finishing around March  -  I am beginning to wonder if I am reverting to episodic again, but the current pattern of reduction is in no way like the previously experienced patterns of reduction.
In short, the improvement continues but the journey is not yet over. Grin
Sorry for all the detail but I am trying to give you the full picture. Stick with the Verapamil, in my case it initially appeared to have no effect, such that, after a few weeks  I asked my GP to increase the dose, which he refused to do, then the changes began.
Good Luck  -  I hope you experience similar relief.
JoeKen. Smiley
Back to top
  

Not sure I should be here, but it's as near as I'm going to get to finding out what is the correct name for my condition. Usually KIP 5 or below but last up to 16 hours and always one-sided, behind the eye, usually right but ocassionally left.
 
IP Logged
 
j0hnglist
CH.com Junior
**
Offline


I Love CH.com!


Posts: 40
Re: Verapamil Changed HAs ?
Reply #6 - Apr 30th, 2009 at 5:12pm
 
no, thank you for the detail.
I am concerned on the quality of my neuro as he told me to get off Verapamil immediately. I refuse cause I think the severity of my attacks has decreased already.
Back to top
  
 
IP Logged
 
JoeKen
CH.com Veteran
***
Offline


Late Life Sufferer.


Posts: 103
x1||England|europe|177|212|
Gender: male
Re: Verapamil Changed HAs ?
Reply #7 - Apr 30th, 2009 at 5:48pm
 
Hi jOhnglist,
I am no medic but I would counsel you against going against your neuro's advice  -  he may be aware of other aspects of your health care that I (and possibly you) are not aware of. For instance Verapamil is also prescribed for, and can have unintended side effects of, lowering the blood pressure.
I do not know where you are located but here in the UK we are allowed to seek a second opinion if we have any problems with any medic or any care or advice they provide. I would advise you to seek a second opinion, preferably from a Neuro who specialises in CH, Migraine etc. BEFORE ignoring his advice.
JoeKen. Smiley
Back to top
  

Not sure I should be here, but it's as near as I'm going to get to finding out what is the correct name for my condition. Usually KIP 5 or below but last up to 16 hours and always one-sided, behind the eye, usually right but ocassionally left.
 
IP Logged
 
j0hnglist
CH.com Junior
**
Offline


I Love CH.com!


Posts: 40
Re: Verapamil Changed HAs ?
Reply #8 - Apr 30th, 2009 at 6:08pm
 
good point. however, he has not done any tests on me yet. he has no blood work or anything yet. I just came in and right away told him I am on Verapanil. He said no that I should get off of it. Weird huh?
Back to top
  
 
IP Logged
 
JoeKen
CH.com Veteran
***
Offline


Late Life Sufferer.


Posts: 103
x1||England|europe|177|212|
Gender: male
Re: Verapamil Changed HAs ?
Reply #9 - Apr 30th, 2009 at 6:19pm
 
VERY WEIRD !!!!, and how much is he paid for this insight into your condition?
Get a second opinion URGENTLY  -  he doesn't sound like a specialist in CH or any other head pains.
JoeKen.
Back to top
  

Not sure I should be here, but it's as near as I'm going to get to finding out what is the correct name for my condition. Usually KIP 5 or below but last up to 16 hours and always one-sided, behind the eye, usually right but ocassionally left.
 
IP Logged
 
DennisM1045
CH.com Alumnus
***
Offline


One wave at a time!


Posts: 3437
Haverhill, Massachusetts, USA
Gender: male
Re: Verapamil Changed HAs ?
Reply #10 - May 1st, 2009 at 7:23am
 
I'm with JoeKen on this one.  Find another Neuro ASAP.

-Dennis-
Back to top
  

Where there is life, there is hope.
Where there is Oxygen, you must use proper caution.
So be safe, don't smoke while using O2. Kill the pain and not yourself.
dennism1045 dennism1045 524417261 DennisM1045 DennisM1045  
IP Logged
 
Page Index Toggle Pages: 1
Send Topic Print

DISCLAIMER: All information contained on this web site is for informational purposes only.  It is in no way intended to be used as a replacement for professional medical treatment.   clusterheadaches.com makes no claims as to the scientific/clinical validity of the information on this site OR to that of the information linked to from this site.  All information taken from the internet should be discussed with a medical professional!