Conflict of Interest: None
Verapamil for Cluster Headache. Clinical Pharmacology and Possible Mode of Action
Article first published online: 29 OCT 2008
© 2008 the Authors. Journal compilation © 2008 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 49, Issue 1, pages 117–125, January 2009
How to Cite
Tfelt-Hansen, P. and Tfelt-Hansen, J. (2009), Verapamil for Cluster Headache. Clinical Pharmacology and Possible Mode of Action. Headache: The Journal of Head and Face Pain, 49: 117–125. doi: 10.1111/j.1526-4610.2008.01298.x
- Issue published online: 5 JAN 2009
- Article first published online: 29 OCT 2008
- Accepted for publication July 21, 2008.
- cluster headache;
- Ca2+ channels
Verapamil is used mainly in cardiovascular diseases. High-dose verapamil (360-720 mg) is, however, currently the mainstay in the prophylactic treatment of cluster headache. The oral pharmacokinetics are variable. The pharmacodynamic effect of verapamil, the effect on blood pressure, also varies considerably among subjects. The dose of verapamil used for cluster headache is approximately double the dose used in cardiovascular disease, most likely because verapamil is a substrate for the efflux transporter P-glycoprotein in the blood–brain barrier. The access of verapamil to the central nervous system is therefore limited. The clinical use of verapamil in cluster headache is reviewed and several relevant drug interactions are mentioned. Finally, its possible mode of action in cluster headache is discussed. The effect of verapamil in cluster headache most likely takes place in the hypothalamus.Verapamil is an L-type calcium channel blocker but it is also a blocker of other calcium channels (T-, P-, and possibly N- and Q-type Ca2+ channels) and the human ether-a-go-go-related gene potassium channel. With so many different actions of verapamil, it is impossible at the present time to single out a certain mode of action of the drug in cluster headache.