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Added Depakote to my Verapamil (Read 957 times)
DeStijl
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Added Depakote to my Verapamil
Dec 25th, 2009 at 12:39am
 
This past month has been nasty. Up until 3 weeks ago the Verapamil (480mg/day) has kept the beast at bay mostly on its own. Now I am back to 2-3 every night, and 1-2 randomly throughout the day.
The neuro suggested the adding of Depakote (500mg/day). I started this 3 days ago. It has yet to build up enough to work, but I am hopeful.
I am not able to take Lithium, it wreaked havoc on my system after taking the 1st tablet. Topamax turned me into a quivering suicidal recluse with anger management issues.
He did suggest trying Topamax again, I said hell no dude! He said that Depakote, although it is a seizure medication as well, WOULD NOT affect me like Topamax. We shall see.
In the meantime, I got another years prescription for Imitrex shooters, nasal spray, and bought a flat of 24 Rockstars at Big Lots. I should be ok. And of course the ever present OXYGEN...woot!
I just hope that bastard goes away before next semester starts on Jan 13. (btw got my 1st semester grades...3.75 GPA art major ftw!)
PFDN,
Eric
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Bob Johnson
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Re: Added Depakote to my Verapamil
Reply #1 - Dec 25th, 2009 at 4:21pm
 
You've been around here long enough to know that many folks take upwards of 900mg Verap. Is there any barrier to you trying that before changing to a new med?
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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).
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Bob Johnson
 
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DeStijl
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Re: Added Depakote to my Verapamil
Reply #2 - Dec 26th, 2009 at 6:01pm
 
No barriers, for some reason neuro didn't want to. He said this would work better adding another instead.
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