High Dose Verapamil Problematic in Cluster Headache Treatment

by Teri Robert, MyMigraineConnection Lead Expert

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Cluster headaches are often said to be the most painful of all headaches. They have been described as "boring," bearing, burning," "like a hot poker in the eye," and as "suicide headaches."

Verapamil, a calcium channel blocker frequently used for Migraine and headache prevention – increasingly for cluster headache, was recently studied in high doses for cluster headache prevention.


Study Background

The use of high dose verapamil has become increasingly common for the prevention of CH, with higher doses than used for heart conditions and hypertension needed. Side effects include atrioventricular block* and bradycardia**, although how frequently they occur in CH patients is not clear. There are no formal guidelines for the use of verapamil for CH. The authors of this study have developed a protocol, keeping in mind the potential for cardiac complications and reviewed the use of the protocol and the changes seen in EKG readings.


Study Method

The charts of patients with episodic cluster headache (ECH) or chronic cluster headache (CCH) attending the Headache Clinic at the National Hospital for Neurology and Neurosurgery from September, 2001, to September, 2005, were reviewed. Patients had a diagnosis of CH consistent with the second edition of the International Classification of Headache Disorders made by at least one doctor at the Headache Clinic.



  • Patients with CH were started on 240 mg of verapamil daily.
  • The dosage was increased by 80 mg every 2 weeks and an EKG performed until the CH was suppressed, side effects intervened, or to a maximum daily dose of 960 mg.
  • EKGs were performed after 2 weeks to account for the time taken for the effect of verapamil dose changes to settle.
  • EKGs were performed either on the hospital site or by local practitioners if the distance from the clinic and travel were difficult.
  • One patient had 1,000 mg and one had 1,200 mg daily by their own decision.
  • The ordinary release formulation of the medicine and not the controlled release formulation were used.
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