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        Cluster Headache Help and Support >> Cluster Headache Specific >> Verapamil Effectiveness Changing?
        
(Message started by: slhaas on Jan 3^rd, 2008, 5:26pm)

Title: Verapamil Effectiveness Changing?
Post by slhaas on Jan 3^rd, 2008, 5:26pm

Hey all... it's been a while, but I'm back. I had a really bad cycle about a year ago... maybe 14 months. I was superbly helped by some great people and tried CB. It was a strange & unpleasant experience for me, but it gave me the longest PF stage of my life since this has all begun.

The beast came back in October, and I can't try the CB treatment this time around so I went back to the imitrex/oxygen/verapamil/prednisolne treatment. It's worked quite well in the past. Once the verapamil kicks in it's usually a PF life with the occasional small hit here & there.

All was going well this time around as well, but I've noticed that the night time (REM triggered) hits were happening a little more frequently this time around. Maybe one every couple of weeks, and around 7-9 on the kip scale, so they haven't been shadows. This seems a little more than last time around. I attributed one of these hits to my stopping verapamil to see if the cycle was done, but I've been back on it (daily ER dose) for 2 weeks now and it hit. The only thing I can think of the most recent hit (last night) was that about 36hrs before that I'd taken an imitrex, and sometimes I have rebounds, but it was strong for a rebound, it was a long time after the dose, it was REM triggered and not day-time. Has anyone else experienced this in needing a dosage change, a drug change perhaps, or is this normal and to be expected?

Title: Re: Verapamil Effectiveness Changing?
Post by Kevin_M on Jan 3^rd, 2008, 6:31pm

on 01/03/08 at 17:26:49, slhaas wrote:

Once the verapamil kicks in it's usually a PF life with the occasional small hit here & there.

... hits were happening a little more frequently this time around. Maybe one every couple of weeks, ...

If it's only one hit in a couple weeks time, that's not bad, nothing's foolproof with this. Could even be a missed dose or just took it at a different time of day.

Title: Re: Verapamil Effectiveness Changing?
Post by slhaas on Jan 3^rd, 2008, 6:43pm

on 01/03/08 at 18:31:40, Kevin_M wrote:

If it's only one hit in a couple weeks time, that's not bad, nothing's foolproof with this. Could even be a missed dose or just took it at a different time of day.

This is true... with the holidays I know I missed a dose or 2 and that it wasn't always taken at the same time. However, I was unaware that with the Verapamil ER caps this was an issue.

Title: Re: Verapamil Effectiveness Changing?
Post by Kevin_M on Jan 3^rd, 2008, 6:45pm

I use SR, sustained release, same thing I guess. Happens to me. They last about 12 hours, coverage should be consistent.

Title: Re: Verapamil Effectiveness Changing?
Post by chewy on Jan 3^rd, 2008, 7:03pm

Try melatonin for the nighttime hits.

Title: Re: Verapamil Effectiveness Changing?
Post by Bob_Johnson on Jan 4^th, 2008, 8:13am

SLOW-RELEASE VERAPAMIL

Dr. Sheftell applauded the protocol for verapamil used by Dr. Goadsby and colleagues, which entailed use of short-acting verapamil in increments of 80 mg. “This method was suggested by Lee Kudrow, MD, 20 years ago as an alternative to slow-release verapamil,” Dr. Sheftell noted.

“I would agree with using short-acting verapamil, rather than the sustained-release formulation, in cluster headache,” he said. “I prefer the short-acting formulation with regard to ability to titrate more accurately and safely. My clinical experience anecdotally demonstrates improved responses when patients are switched from sustained-release verapamil to short-acting verapamil.”

Dr. Goadsby agreed that his clinical experience was similar. “There are no well-controlled, placebo-controlled, dose-ranging studies to direct treatment. This is one of those areas where clinicians who treat cluster headache have to combine what modicum of evidence is available with their own clinical experience,” Dr. Sheftell commented.

Title: Re: Verapamil Effectiveness Changing?
Post by E-Double on Jan 4^th, 2008, 9:42am

Sheftell is my doc and once we changed from extended or sustained release to short acting, we were able to gain much more stability and knock it down a notch