From the Research
Diltiazem is not typically recommended as a first-line treatment for headache prevention, and its use should be considered with caution due to limited evidence supporting its efficacy in this context 1. For migraine prevention, when calcium channel blockers are considered, the usual diltiazem dosage ranges from 120-360 mg daily, often divided into multiple doses. Treatment typically starts at a lower dose (such as 120 mg daily) and is gradually increased as needed and tolerated. Extended-release formulations may be preferred for better compliance with once-daily dosing. Diltiazem works by blocking calcium channels in blood vessels, which helps prevent vasospasm and reduces neurogenic inflammation that contributes to headaches. However, other calcium channel blockers like verapamil (120-360 mg daily) are more commonly used for headache prevention. Before starting diltiazem, patients should be aware of potential side effects including dizziness, constipation, and hypotension, and should inform their healthcare provider about all medications they take to avoid interactions. Blood pressure monitoring is important during treatment, and the medication may take several weeks to show full preventive effects. Some studies suggest that diltiazem may be effective in treating certain types of headaches, such as those induced by capecitabine 2, but its role in migraine prevention is less clear. Key considerations for the use of diltiazem in headache prevention include:
- Limited evidence supporting its efficacy
- Potential side effects, such as dizziness and hypotension
- Importance of blood pressure monitoring
- Gradual dose titration to minimize adverse effects
- Alternative treatment options, such as verapamil or other calcium channel blockers, may be more effective or better tolerated. Given the limited evidence and potential risks, diltiazem should only be considered for headache prevention under the guidance of a healthcare provider and with careful monitoring of its effects 1.