Verapamil an effective prophylactic drug in the treatment of Cluster headache, confirms review

In a narrative review of efficacy, mechanisms and perspectives of Verapamil use in Cluster Headache appearing in Journal Headache the researchers have confirmed Verapamil as an effective prophylactic drug in the treatment of Cluster headache.

Cluster headache (CH), the most common trigeminal autonomic cephalalgia, is an extremely debilitating primary headache disorder that is often not optimally treated. Verapamil has been used in the prevention of Cluster Headache for almost 3 decades, however, the mode of action and the therapeutic target is still unknown. Verapamil was developed initially because of its vasodilatory effect, and along with other calcium channel blockers (CCB), it was widely used to treat cardiovascular diseases.

Dr Petersen AS and colleagues at Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup, Glostrup, Denmark have conducted a study to evaluate the effect of verapamil and other calcium channel blockers in cluster headache (CH) treatment and an investigation of possible effect mechanisms.They have presented a review of Efficacy, Mechanisms and Perspectives of role of verapamil and other calcium channel blockers in cluster headache (CH) treatment

The researchers conducted a Pubmed search: "Verapamil"[Mesh] and "Cluster Headache"[Mesh] and identified 5 relevant studies for Cluster Headache. Publications were included if they made a substantial contribution within 3 prespecified areas: Efficacy (randomized controlled-trials or open labels studies), safety, and mechanism of effect. Publications highlighting mechanism of action in central nervous system disorders were included.

The researchers noted that Clinical preventive treatment of Cluster headache with verapamil was based on 2 randomized controlled studies and 3 open-label studies. In total, 183 Cluster headache patients participated. Verapamil 360 mg/day was used in both controlled studies. Half of the chronic patients experienced benefit from verapamil treatment and the attack burden of episodic patients was, on average, reduced by 1 attack/day. Open-label studies support a dose-dependent level of efficacy. Mechanism of effect: Human and animal studies indicate that verapamil may exert its effect by modulating circadian rhythms, perhaps in central pacemakers, and/or by affecting the release of calcitonin gene-related peptide.

The investigators concluded that Verapamil appears to be an effective prophylactic drug in the treatment of CH and despite the scarcity of controlled trials, it is still the drug of choice.The available trials, clinical experience, and the test of time have proven that verapamil, in particular, is an effective treatment.A chronotherapeutic approach might increase the effect. More basic and pharmacokinetic research is needed before the mechanism can be fully understood.

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Headache.DOI: 10.1111/head.13603