Bob Johnson
CH.com Alumnus
 
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"Only the educated are free." -Epictetus
Posts: 5965
Kennett Square, PA (USA)
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1. It's the most widely used and effecive preventive we have, but 2. folks don't understand that it takes several days before becoming effective, hence using prednisone to abort attacks while the V builds up. 3. Low dosing major source of failure, often reflecting docs who don't know how to treat Cluster. 4. Least likely source of failure is that one doesn't have Cluster--diagnosis. (See: Link to: cluster-LIKE headache: Section, "Medications, Treatments, Therapies --> "Important Topics" --> "Cluster-LIKE headache") 5. Call to your doc's attention. -- J Headache Pain. 2011 Apr;12(2):173-6. Epub 2011 Jan 22. Cardiac safety in cluster headache patients using the very high dose of verapamil (=720 mg/day). Lanteri-Minet M, Silhol F, Piano V, Donnet A. SourceDépartement d'Evaluation et traitement de la Douleur Médecine palliative, Pôle Neurosciences Cliniques du CHU de Nice, Hôpital Pasteur Avenue de la Voie Romaine, 06002 Nice Cedex, France. lanteri-minet.m@chu-nice.fr
Abstract Use of high doses of verapamil in preventive treatment of cluster headache (CH) is limited by cardiac toxicity. We systematically assess the cardiac safety of the very high dose of verapamil (verapamil VHD) in CH patients. Our work was a study performed in two French headache centers (Marseilles-Nice) from 12/2005 to 12/2008. CH patients treated with verapamil VHD (=720 mg) were considered with a systematic electrocardiogram (EKG) monitoring. Among 200 CH patients, 29 (14.8%) used verapamil VHD (877±227 mg/day). Incidence of EKG changes was 38% (11/29). Seven (24%) patients presented bradycardia considered as nonserious adverse event (NSAE) and four (14%) patients presented arrhythmia (heart block) considered as serious adverse event (SAE). Patients with EKG changes (1,003±295 mg/day) were taking higher doses than those without EKG changes (800±143 mg/day), but doses were similar in patients with SAE (990±316 mg/day) and those with NSAE (1,011±309 mg/day). Around three-quarters (8/11) of patients presented a delayed-onset cardiac adverse event (delay =2 years). Our work confirms the need for systematic EKG monitoring in CH patients treated with verapamil. Such cardiac safety assessment must be continued even for patients using VHD without any adverse event for a long time.
© The Author(s) 2011. This article is published with open access at Springerlink.com
PMID:21258839[PubMed] -- Sounds grim but not a major problem when you doc knows the need for monitoring.
6. See PDF file, below.
7. You're too young to play doctor anymore! <bg>
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