From the Research
The best prophylactic medication for this patient's headaches is verapamil (Verelan). This patient is experiencing cluster headaches, characterized by severe unilateral retro-orbital pain, autonomic symptoms (tearing, rhinorrhea), short duration (about an hour), and cyclical pattern with periods of remission. Verapamil, a calcium channel blocker, is considered first-line prophylactic therapy for cluster headaches as it helps prevent the vasodilation associated with these attacks 1, 2.
Key Considerations
- The patient's history of hypertension and uterine fibroids (Leiomyomas) should be taken into account when selecting a prophylactic medication, but verapamil remains a suitable option.
- The dosage of verapamil may need to be adjusted based on individual patient response, with some patients requiring higher doses to achieve adequate control of symptoms 3.
- Other prophylactic options, such as lithium, topiramate, and gabapentin, may be considered if verapamil is ineffective or contraindicated 4, 1, 2.
- It is essential to monitor the patient's electrocardiogram (ECG) before and during treatment with verapamil due to its potential cardiac side effects 1.
Treatment Approach
- Verapamil should be initiated at a low dose and gradually increased until the patient achieves adequate control of symptoms or experiences side effects.
- The patient should be educated on the importance of keeping a headache diary to track the frequency and severity of attacks and to adjust the treatment plan as needed.
- Regular follow-up appointments should be scheduled to monitor the patient's response to treatment and to adjust the dosage or add other prophylactic medications as necessary.