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Verapamil For Migraines

verapamil for migraines

Is Verapamil Safe for Preventing Migraines?

Has the long-term use of verapamil for migraines been studied? Do you recommend the use of daily migraine drugs to prevent the attack or drugs used only when migraine symptoms appear?

Of the calcium channel blockers available in the United States, verapamil is the most effective for migraine prevention. Evidence for its efficacy to prevent migraine is rated as 2-plus on a scale of 0 to 4-plus. For comparison, beta-blockers, tricyclic anti-depressants, Topamax (topiramate) and Depakote (divalproex) rate as 4-plus for efficacy.

Verapamil has been used to treat hypertension (high blood pressure) for over 25 years. It is very safe to take verapamil on a long-term basis.

The decision to recommend preventive medication to any migraine patient must be made on a case-by-case basis. In general, preventive treatment is usually given daily for months or years.

Circumstances that warrant chronic, long-term treatment include: two or more attacks a month that produce disability that last three or more days; ineffectiveness of symptomatic medications or medical reason not to take them; use of abortive medication more than twice a week, or special circumstances, such as hemiplegic migraine or rare headache attacks producing profound disruption or risk of permanent neurologic injury.

Possible Verapamil Side Effects

Of course, if you are taking a blood pressure medication when you really don’t have high blood pressure that can introduce problems and side effects as well (which I alluded to above with propranolol). In verapamil’s case, you’ll want to keep an eye out for certain side effects that may occur:

Constipation – the calcium channel blockers are notorious for causing constipation. This usually occurs in around 7% of patients

Dizziness – about 3% of patients

Hypotension (low blood pressure)

Nausea – not common but can happen.

How Long for Verapamil to Prevent Migraines?

Generally speaking, the dose of verapamil to prevent migraines is usually given in three or four divided dose throughout the day. The total daily dose can range from 160 mg to 320 mg a day. Of course, a lot of this will depend on your doctor’s preference and how well you respond to verapamil out of the gate.

You’ll likely start seeing positive results from verapamil in about 4 to 6 weeks. In studies looking at verapamil they found that most patients starting seeing a drop in the frequency and severity of their migraines by the end of the first month of treatment. In rare cases, it may take as long as 8 weeks.

Drug interactions

Histamine antagonists - As with the beta blockers, cimetidine (Tagamet) has been reported to inhibit metabolism of these medications. Therefore, lower doses of the calcium channel blockers should be used when this drug is used concurrently.

Beta blockers - Beta blockers have been used in combination with calcium channel blockers with heightened efficacy in some patients. However, co-administration may also results in increased side effects due to depression of the contractility of the heart muscle and slowing of the heart rhythm. Patients should be regularly monitored at frequent intervals for hypotension, bradycardia, and cardiac failure.

Carbamazepine (Tegretol) - Levels of carbamazepine have been reported to be increased when used in combination with calcium channel blockers. Carbamazepine is a frequently used anti-seizure medicine and is often used for pain disorders, such as tic douloureux. When these drugs are used concurrently, therefore, serum carbamazepine levels should be monitored and adjusted accordingly.

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