From the Guidelines
Calcium channel blockers (CCBs) are not recommended as a first-line treatment for headache prophylaxis due to their modest effect and potential side effects, as evidenced by the poor quality of evidence for nifedipine, nimodipine, cyclandelate, and verapamil 1. When considering CCBs for headache prophylaxis, it is essential to weigh the potential benefits against the risks of adverse events, such as dizziness, edema, flushing, and constipation.
- The evidence for CCBs in migraine prevention is limited, with most studies suggesting only a modest effect 1.
- Flunarizine, a CCB available in some countries, has proven efficacy in migraine prevention at a dose of 10 mg/d, but its use is associated with sedation, weight gain, and abdominal pain, as well as depression and extrapyramidal symptoms in elderly patients 1.
- In clinical practice, CCBs may be considered for patients with specific comorbidities, such as hypertension, or those who cannot tolerate first-line preventive medications, but their use should be carefully monitored due to potential side effects.
- The lack of strong evidence for CCBs in headache prophylaxis highlights the need for further research to determine their efficacy and safety in this context 1.
From the Research
Calcium Channel Blockers for Headache Prophylaxis
- Calcium channel blockers (CCBs) are used in the prophylactic treatment of cluster headaches, with verapamil being the most commonly used 2, 3, 4, 5.
- Verapamil has been shown to be effective in reducing the frequency and severity of cluster headache attacks, with a dose-dependent level of efficacy 3.
- The exact mechanism of action of verapamil in cluster headache is still unknown, but it is thought to involve the modulation of circadian rhythms and the release of calcitonin gene-related peptide 3, 4.
- Other CCBs, such as flunarizine, may also be used in the prophylactic treatment of migraines, although the evidence for their effectiveness is limited 6.
Dosage and Administration
- The dosage of verapamil used for cluster headache prophylaxis is typically higher than that used for cardiovascular disease, ranging from 240 to 480 mg per day 2, 3.
- The dosage may need to be individualized, with some patients requiring higher or lower doses to achieve adequate control of their symptoms 2.
- Verapamil is usually administered in divided doses, with the majority of patients requiring 3-4 doses per day 2, 3.
Efficacy and Safety
- Verapamil has been shown to be effective in reducing the frequency and severity of cluster headache attacks, with a response rate of 50-80% 2, 3.
- The safety profile of verapamil is generally good, although it can cause side effects such as fatigue, dizziness, and constipation 2, 3.
- Other CCBs, such as flunarizine, may also be effective in the prophylactic treatment of migraines, although the evidence for their effectiveness is limited 6.