Hi Maria

Verapamil is normally started at 240mg a day - 80mg 3 times a day. Make sure that is Verpamil BP, not the SR(Slow Release) or MR (Modified Release) The strength of the tablet is increased every two weeks until it is effective in stopping cluster attacks or until the maximum dose of 960mg per day is reached. And you must have ECG's before starting the treatment and before every increase.

From the OUCH(UK) website;

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However, verapamil can have side effects including 'heart block' (a block in the conduction of the normal impulses of the heart). It is therefore mandatory that individuals are given an ECG before taking the drug, and then again each time the dose is increased to check for any potential abnormalities.

Rod

This is a widely used approach:

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).

Maria

The current regime for Verapamil as recommended by  Professor Peter J. Goadsby  THE NATIONAL HOSPITAL FOR NEUROLOGY AND NEUROSURGERY, QUEEN SQUARE is ,

starting dose 80mg - 3 times a day for 2 weeks, increasing by 80mg every 2 weeks. Remember the ECGs.  Also avoid grapefruit/grapefruit juice as this can cause adverse side effects.

Maria, my dosage of Verap is 480mg daily. Last cycle I went right onto the full dose and ended up in the ER as I was passing out, heart rate and blood pressure way too low.
I know now to slowly increase the dose until I reach my 480mg amount, and the same when tapering back off.

Hope this works for you, and do you have o2 to abort? Works for most of us here, read to your left on this.

 Barry

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He's been brilliant and is also referring me to a recommended specialist by OUCH so all should go well for me

Who?