Obviously a lot of people on this forum would be using verapamil as a preventer for their CH. I don't want to unduly alarm people but I think it is worth telling my story as it may be worth having your liver function tested.

I have CH that I would describe as relatively mild compared to many sufferers, and it first came on about 18 months ago. At first I was happy to just use abortive measures such as oxygen and Maxalt. However a few months ago I was getting rather sick of it and went to my doctor to get some verapamil to try.

I started on a low dose of just 2 x 80mg daily and got some benefit after about a week. However a few weeks later I started getting some occasional moderate hits so increased the dose to 3 x 80mg (as my doctor had suggested).

I was pretty pleased that at a fairly low dose (in terms of CH) I was getting much decreased intensity and frequency and seemingly no side effects. I was really happy how it was going.

About a week ago I had an episode of chest pain. It persisted for a couple of hours and I decided I had better get myself checked out, so off to hospital. The hospital ran some routine blood tests, fortunately including liver function. In doing so they discovered that I had greatly elevated levels of liver enzymes, indicating liver damage. There was no imediate obvious cause for this since I am not a heavy drinker. It also happened that I had blood tests done only a couple of months ago (before verapamil) and my liver function was fine then. So this had happened in a relatively short time frame.

There seems to be no other explanation other than that this damage was caused by verapamil. A liver ultrasound showed no structural abnormality in terms of obstruction etc. Liver damage is a known side effect of verapamil. One reference I looked at said it occurred in around 1% of cases.

As an example one of my liver enzymes known as GGT was 1,564 whereas the normal range is said to be less than 62!!

Needless to say I came straight off the verapamil. Since the liver has great powers of regeneration it should repair itself. There was a slight improvement in the blood tests done a few days later, but I will get retested in a week or two. The hospital will arrange for me to be seen as an outpatient some time in the next few weeks to check my progress.

One of the main points of this story is that I had no idea this was happening. There were no side effects of any sort. I felt completely well. The hospital pharmacist said that had I continued on the drug two thirds of my liver would have been destroyed before I got any symptoms at all. I am almost thankful that I got the chest pain and went to hospital otherwise I would have been blissfully unaware of this problem until it got very nasty!

Clearly the majority of people taking verapamil won't have this problem, so don't get unduly alarmed. However in light of my experience my recommendation would be to get a liver function test done approx 1 month after starting on verapamil for the first time. I guess if you have been on it for years without any problem then you are probably not susceptible to this effect (but I guess it wouldn't hurt to get a blood test anyway for peace of mind).

By the way, the tests I had done on my heart showed that it was in good shape so I didn't have a heart attack and I don't have coronary artery disease. The hospital are also going to arrange a consultation with a neurologist in their headache clinic to review my CH and discuss alternative options since I can't take verapamil.

It also has me interested that one drug reference I checked lists side effects of: chest pain, angina and heart attack. Leaves me wondering if the verapamil may be implicated in the chest pain I got.

BD - glad you caught that in time... wow! I've never tried verapamil although I know that many people here swear by it.

When I first visited my neurologist (finally) about my  longtime CH he put me on Topomax. I'd read about verapamil. He simply said "that's an old-fashioned treatment". Well to be accurate he might not have used the word old-fashioned exactly, but that was the implication.

Mind you I don't have a problem with older drugs that work. If they do.

Hope you get on a successful treatment program pronto. You might ask about Topomx (Topirimate) but of course there are many other ways to get at the beast. Be sure and ask about oxygen, plus look for a thread here about the D3 vitamin regimen. It's there under this heading somewhere.

The old problem of making decisions about what med to use based on 1-2, few comments posted here.

At the very least, read the good studies which are available to guide you decision making.
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Re. Lithium: Has been used for many years and so the track record of side effects/safety is well known. When used appropriately, it's safe. The side effects are clear and, when used, regular blood tests monitor the blood level so that toxic reactions are kept in check.

Feds require publishing side effect data, which is readily available to us for all prescription meds. The potential ranges from less than 1/2%, upward. So, we have data to give us a guide to use these meds.

The hooker are the supplement products for which no data on side effects are required.