Titre du document / Document title
Individualizing treatment with verapamil for cluster Headache patients
Auteur(s) / Author(s)
BLAU Joseph N. (1) ; ENGEL Hans O. (1) ;
Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
(1) City of London Migraine Clinic, ROYAUME-UNI

Résumé / Abstract
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.
Revue / Journal Title
Headache   ISSN 0017-8748   CODEN HEADAE 
Source / Source
2004, vol. 44, no10, pp. 1013-1018 [6 page(s) (article)] (15 ref.)
Langue / Language
Anglais

Editeur / Publisher
Blackwell, Malden, MA, ETATS-UNIS  (1961) (Revue)

Mots-clés anglais / English Keywords
Sulfonamide ; 5-HT1 Serotonine receptor ; Agonist ; Vascular disease ; Cardiovascular disease ; Calcium antagonist ; Neurological disorder ; Central nervous system disease ; Cerebral disorder ; Triptan derivatives ; Anticonvulsant ; Antimigrainous agent ; Pain ; Valproic acid ; Sumatriptan ; Cluster headache ; Chemotherapy ; Migraine ; Headache ; Chronic ; Human ; Cerebrovascular disease ; Verapamil ; Treatment ; Nervous system diseases ;
Mots-clés français / French Keywords
Sulfonamide ; Récepteur sérotoninergique 5-HT1 ; Agoniste ; Vaisseau sanguin pathologie ; Appareil circulatoire pathologie ; Antagoniste calcium ; Trouble neurologique ; Système nerveux central pathologie ; Encéphale pathologie ; Triptan dérivé ; Anticonvulsivant ; Antimigraineux ; Douleur ; Acide valproïque ; Sumatriptan ; Céphalée vasomotrice Horton ; Chimiothérapie ; Migraine ; Céphalée ; Chronique ; Homme ; Cérébrovasculaire pathologie ; Vérapamil ; Traitement ; Système nerveux pathologie ;
Mots-clés espagnols / Spanish Keywords
Sulfonamida ; Receptor serotoninérgico 5-HT1 ; Agonista ; Vaso sanguíneo patología ; Aparato circulatorio patología ; Antagonista calcio ; Trastorno neurológico ; Sistema nervosio central patología ; Encéfalo patología ; Triptán derivado ; Anticonvulsivante ; Agente antimigrañoso ; Dolor ; Acido valproico ; Sumatriptán ; Cefalea vasomotriz Horton ; Quimioterapia ; Jaqueca ; Cefalea ; Crónico ; Hombre ; Vaso sanguíneo encéfalo patología ; Verapamilo ; Tratamiento ; Sistema nervioso patología ;
Mots-clés d'auteur / Author Keywords
cluster headache ; treatment ; verapamil ;
Localisation / Location
INIST-CNRS, Cote INIST : 17409, 35400012129020.0090


Nº notice refdoc (ud4) : 16330982

Marc,

In my experience, Verapamil loses effectiveness over long periods of time - again, I'm speaking of my experience only.

I've been taking it for about 12 years, but I have to take a break from it, or start increasing the dosage. This occurs roughly every two to three years for me.

After a 30-60 day break, the magic returns full blast.

One more thing: I saw a huge improvement when I switched from SR to regular release, taken three times per day - really big difference.

Marc

I just went from 120 to 240 today.  I'm worried about the constipation.  In my last cycle, two years ago, I was very constipated.  I remember trying colace a couple times a day and that definitely didn't work.  Any suggestions??