Neurol. praxi. 2025;26(1):54-60 | DOI: 10.36290/neu.2025.001

Verapamil in the preventative treatment of cluster headache

MUDr. Pavel Řehulka, Ph.D.¹, PharmDr. MVDr. Vilma Vranová, Ph.D.², PharmDr. Jitka Rychlíčková^{3, 4}, MUDr. Martin Pešl, Ph.D.^{5, 6, 7}

¹ I. neurologická klinika Lékařské fakulty Masarykovy univerzity a Fakultní nemocnice u sv. Anny v Brně

² Ústav aplikované farmacie, Farmaceutická fakulta Masarykovy univerzity, Brno

³ Farmakologický ústav, Lékařská fakulta Masarykovy univerzity, Brno

⁴ Nemocniční lékárna, Fakultní nemocnice u sv. Anny v Brně

⁵ I. interní klinika, Kardioangiologie, Lékařská fakulta, Masarykova univerzita, Brno

⁶ Mezinárodní centrum klinického výzkumu, Fakultní nemocnice u sv. Anny a Lékařská fakulta, Masarykova univerzita, Brno

⁷ Biologický ústav, Lékařská fakulta, Masarykova univerzita, Brno

Cluster headache is a primary headache disorder classified under trigeminal autonomic cefalalgias. Its treatment is based on empirical recommendations and includes acute, preventative and bridging treatment strategies, and complemented by neuromodulatory methodes. Verapamil is considered first-line preventative medication, although its use in cluster headache is off-label. The treatment should be started at the very beginning of the cluster period with an initial dose of 240 mg/day, prior it is mandatory to rule out contraindications and confirm that patient´s echocardiographic finding is normal. During the first week of treatment, the typical effective therapeutic dose of 360 mg/day is achieved. Further increase of the dose is provided stepwise according the needs of the patient and with routine electrocardiogram monitoring. If high (≥ 480 mg/day) or very high doses (≥ 720 mg/day) of verapamil are necessary, treatment should be administered under the specialist´s supervision with close cardiological follow-up. The maximu recommended dose for preventative treatment of cluster headache is 960 mg/day. Preventative treatment usually continues for several weeks or months and must be withdrawn gradually.

Keywords: cluster headache, trigeminal autonomic cephalalgias, pain management, therapeutics, calcium channel blockers, verapamil.

Received: December 11, 2024; Revised: January 7, 2025; Accepted: January 10, 2025; Prepublished online: January 10, 2025; Published: March 19, 2025  Show citation