After 9 days pain free taking Verapamil and combination the CHS returned so back to the Doc for a consult. He had prescribed Verapamil SR initially and I told  him that regular release was recommended on this sight. He said lets give it a shot and set the dosage at 360 mg a day. After about 2 days they stopped again. It's now 7 days PF and I am down to 320 mg. a day. Maybe we got it right this time. Additionally,I was taking Lithium as well but gave it a pass the second time around. I've had these things long enough to no that there are no sure things but here's hoping. I'm going to continue the Verapamil for another week and if they still haven't returned I will stop it all together. One question though; when coming off it do you have to taper or can you just stop taking it? This is my first experience with it

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.