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Verapamil For Headaches

verapamil for headaches

What is Verapamil?

Verapamil is a type of medication known as a calcium channel blocker.  It comes under many brand names, such as Calan, Covera-HS and Isoptin.  Because of the calcium blocking function, blood vessels are dilated, reducing blood pressure and the amount of oxygen your heart uses.  It also reduces the risk of spasm in blood vessels.  As you may guess, verapamil is commonly used to treat issues like high blood pressure and some other heart and circulatory related problems.

There are many types of calcium channel blockers used in the treatment of migraine.  Verapamil is just one type.  Verapamil is used as a preventative medication.

Preventive medication for episodic cluster headache

Cluster headaches often build in intensity over days or weeks. At first, patients may simply feel twinges of pain on the affected side, and then the intensity slowly builds. Usually, the patients will call or visit the physician 1 week or more into the cluster cycle. Once we believe that the cluster cycle has begun, preventive medication should be instituted.

Cortisone is the fastest acting medication, and we begin with limited amounts of it. Concurrently, the patient is given another first line prevention medication, either lithium or verapamil. When we have withdrawn the cortisone, the second preventive medication will hopefully have become effective.

The preventive medication is discontinuied when the cluster series has finished. If a patient usually experiences a 4 week cycle of clusters, and the current series has lasted 5 weeks with no headache for 1 week, preventive medication may be withdrawn. I wait for the clusters to be gone for 1 or 2 weeks prior to stopping medication. Patients are instructed to quickly reinstitute the preventive medication if the clusters reappear. A cluster series may drag on for extra weeks or months, well beyond what the patient normally experiences.

First line preventive approaches for episodic cluster include: cortisone, verapamil, lithium and polypharmacy (combining two first line medications).

Second line preventive medications include: methysergide (Sansert), valproate (Depakote), daily ergotamines, ergonovine, steroid blockage of the occipatal nerve, daily triptans and Indocin.

Third line preventive medications include; IV dyhydroergotamine (DHE) given repetitively, and cocaine drops used intranasally on a daily basis.

Miscellaneous therapies that are occasionally helpful for episodic clusters include: phenelzine (Nardil), cyproheptadine (Periactin), nifedipine (Procardia), beta blockers such as propranolol (Inderal), SSRI's (Prozac, Zoloft, Paxil), or methylphenidate (Ritalin).

Who takes Verapamil?

Verapamil actually has become an increasingly common medication for migraine of all classes.  However, there are some conditions it’s more likely to be used:

  • Cluster Headache (both chronic and episodic)
  • Hemiplegic Migraine, including both sporadic hemiplegic migraine and familial hemiplegic migraine
  • Migraineurs who already have high blood pressure
  • Migraineurs who can’t take beta blockers (ie because of asthma)
  • Menstrual Migraine
  • Migraine induced by orgasm or exercise
  • Types of migraine with prolonged aura
  • Verapamil has also been used successfully to treat children and adolescents with migraine.

Side effects

Verapamil is a favourite in the class of calcium channel blockers, partly because it’s less likely to cause side effects.  However, as with any medication, some people do experience some.  Most commonly:

  • Constipation
  • Swelling of the feet, ankles or legs
  • Slowing of the heart rate
  • Tiredness or heaviness
  • Light headedness (see above)

There are others, though these tend to be the most common – please talk to your doctor if you notice any side effects.

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