Verapamil and Cluster Headache: Still a Mystery. A Narrative Review of Efficacy, Mechanisms and Perspectives

  title={Verapamil and Cluster Headache: Still a Mystery. A Narrative Review of Efficacy, Mechanisms and Perspectives},
  author={Anja Sofie Petersen and Mads C J Barloese and Agneta Henriette Snoer and Anne Mette Skov Soerensen and Rigmor H{\o}jland Jensen},
  journal={Headache: The Journal of Head and Face Pain},
A evaluation of the effect of verapamil and other calcium channel blockers in cluster headache (CH) treatment and an investigation of possible effect mechanisms. 
Episodic and Chronic Cluster Headache: Differences in Family History, Traumatic Head Injury, and Chronorisk
The diagnostic criteria of episodic and chronic cluster headache were recently modified, yet pathophysiological differences between the two are still unclear, and other differences between episodi and cCH are identified and characterized.
Cluster headache therapies: pharmacology and mode of action
This article reviews acute and preventive substances for the pharmacological treatment of CH with a focus on the mode of action of these drugs, and suggests future studies with CGRP(R) antibodies and novel substances with specific actions are needed to understanding the pathophysiology of CH.
Cluster headache in adults
Cluster headache is characterised by attacks of very severe, unilateral headache lasting 15–180 minutes, up to eight times per day, associated with cranial autonomic symptoms on the same side and a sense of agitation or restlessness.
Peptides, MAbs, Molecules, Mechanisms, and More: Taking a Stab at Cluster Headache.
  • S. Joshi
  • Medicine, Psychology
  • 2020
Recent therapeutic advances in the treatment of cluster headache such as monoclonal antibodies as well as non-invasive vagus nerve stimulation are highlighted, and future potential therapeutic targets are examined.
Recently available and emerging therapeutic strategies for the acute and prophylactic management of cluster headache: a systematic review and expert opinion
A deeper insight into CH pathophysiology, and combined approaches may lead the path to new, more effective, and personalized CH therapies.
Cluster Headache and Other Trigeminal Autonomic Cephalalgias
TAC syndromes are rare but important to recognize because of their debilitating nature and greater likelihood for having potentially serious underlying causes and how best to manage them.
Recent Advances in the Management of Cluster Headache
A deepening of the understanding of cluster headache mechanisms in recent years has driven the evolution of sophisticated therapeutic approaches that could allow a new era in the treatment of this difficult condition.
Pharmacotherapy for Cluster Headache
A new addition to the preventive treatment options in episodic cluster headache is galcanezumab, although the long-term effects remain unknown.
Drug profile: galcanezumab for prevention of cluster headache
The negative trial results of galcanezumab for chronic cluster headache may be due to the refractory nature and sheds light on the critical need to investigate the underlying biology and therapeutic options.
Real-life treatment of cluster headache in a tertiary headache center – results from the Danish Cluster Headache Survey
Episodic cluster headache is more responsive to acute therapy than chronic and sumatriptan injection was more effective than oxygen and the responder-rate was limited with verapamil.


Outpatient Intravenous Dihydroergotamine for Refractory Cluster Headache
Evaluation of the efficacy and safety of outpatient intravenous dihydroergotamine for treatment of refractory cluster headache finds DHE to be safe and effective.
Treatment of Cluster Headache: The American Headache Society Evidence‐Based Guidelines
New evidence‐based treatment guidelines for cluster headache will assist clinicians with identifying and choosing among current treatment options.
Disturbed sleep in cluster headache is not the result of transient processes associated with the cluster period
Investigation of differences in sleep between the bout and remission period in patients with episodic CH found that perturbations of sleep are solely present during the CH bout.
Verapamil in the prophylaxis of episodic cluster headache: A double-blind study versus placebo
A significant reduction in attack frequency and abortive agents consumption in the verapamil group and objective evidence for the effectiveness of verAPamil in episodic cluster headache prophylaxis is provided.
Flunarizine in migraine‐related headache prevention: results from 200 patients treated in the UK
Supportive guidelines for flunarizine use in migraine, based on randomized controlled evidence that it is as effective as propranolol and topiramate in adults in adults, are published.
Verapamil for Cluster Headache. Clinical Pharmacology and Possible Mode of Action
The clinical use of verapamil in cluster headache is reviewed, its possible mode of action is discussed, and several relevant drug interactions are mentioned.
High-Dose Verapamil in Episodic and Chronic Cluster Headaches and Cardiac Adverse Events: Is It as Safe as We Think?
Although available studies seem to demonstrate an apparent good tolerance, this off-label practice should not be considered as standard of care and requires strict cardiac monitoring, as suggested by the Agence Nationale de Sécurité du Médicament (ANSM) in a recent re-evaluation of the benefit/risk ratio of high-dose verapamil used in CH prevention.
Population analyses of sustained‐release verapamil in patients: Effects of sex, race, and smoking
Our objective was to determine the effects of age, sex, and sustained‐release formulation on apparent oral clearance of sustained‐release racemic verapamil in patient populations.
Effect of Infusion of Calcitonin Gene-Related Peptide on Cluster Headache Attacks: A Randomized Clinical Trial
Results suggest anti-CGRP drugs may be effective in cluster headache management and suggest patients with episodic cluster headaches reported attacks after CGRP or placebo but not in remission-phase episodic clusters headache.