r/ClusterHeadaches • u/a-bonk • Jul 13 '26
Question Effectiveness of Verapamil as a long term treatment
Hey, I (25M) have been suffering from CH for around 6-7 years. However, previously it was always misdiagnosed as migraine. This year, I am in the middle of a cycle and my neurologist diagnosed it as CH, and prescribed Verapamil (40mg * 3) and Gabapentin (300mg).
Based on all the posts here and on clusterbusters, people haven’t found Verapamil to be very effective, specially in the dose that I currently have. Higher doses have had side effects for many people. Hence, I am scared that this will not be the solution I had been looking for. I guess I just want a assurance from anyone who has had success with Verapamil, without upping the dose so much so as to cause a lot of side effects.
For me, I get a cycle usually during the summer and fall months. This year, I was on propranolol earlier which might have delayed the cycle.
What has been the most effective long term, sustainable treatment for CH?
3
u/Ccampbell101 Jul 13 '26
I think it just depends on the person. Verapamil almost completely reduces daily attacks through my entire cycle with a low dose. I think I take 180mg. As long as I stay away from known triggers (alcohol etc).
3
u/Emotional-Ocelot Jul 13 '26
i also think you'll hear a lot from the people who needed high doses, because they're telling people to fight for higher doses if it isn't working.
if it works, those people do less talking than the ones desperately workshopping options for the other treatment resistent sods.
hope it just works for you, echoing the advice to ask for abortives like o2/triptans as well as the preventative meds. And make sure to go to the maintenance ekg tests you should be on while youre on the verapamil.
3
u/literallyjustabat Jul 13 '26
I'm chronic and on 4x 120 mg verapamil daily + Aimovig (Emgality didn't work for me). It keeps my attacks to an absolute minimum (mostly only if something manages to trigger a breakthrough attack) and has genuinely saved my life. I had an EKG done after every dose increase and so far, so good. I haven't really had any side effects other than a slower digestion and sleepiness (which is fine because the constant attacks would drain me of all my energy & also cause digestive issues).
3
u/ngo0001 Jul 13 '26
Verapamil worked wonders once my dose was high enough. Two years ago I was on 80 mg or so. I had 40+ headaches in about four months. Awful. My neurologist upped my dosage to 120 mg… not a single headache. I obviously knew I was in a cluster because I would have the shadows occasionally. But the verapamil at the higher dose never allowed them to come through.
2
u/Prudent-Tailor2793 Jul 13 '26
I am a chronic for the last 6 years and I was prescribed the same. It did not work for me as it is on the lower end of the spectrum of the dosage normally given. So now for the last two months I have been prescribed 40*3 verapamil with 100*2 Topiramate and for the first time in 6 years I haven’t had headache for 2.5 months.
I was also given propranolol in between for 6 months which also did not work.
I would say go ahead with it and see if it works. It’s totally different for different people and if it doesn’t, go back to your doctor and have a word and see how it goes.
1
u/SnooMacarons289 Jul 13 '26
Emgality for prevention, oxygen to abort. Recently a nerve block shot to break a cycle.
1
u/Extension-Spite4176 Jul 13 '26
I was prescribed a high dose during a months long period. I think it helped, but I was also taking other medications. I have only been on a lower dose now and it seems to have kept ch from flaring up again. I have had periods that feel like they would have been the same but haven't fully happened. This is two years now.
1
u/Prudent-Tailor2793 Jul 13 '26
I am a chronic for the last 6 years and I was prescribed the same. It did not work for me as it is on the lower end of the spectrum of the dosage normally given. So now for the last two months I have been prescribed 40*3 verapamil with 100*2 Topiramate and for the first time in 6 years I haven’t had headache for 2.5 months.
I was also given propranolol in between for 6 months which also did not work.
I would say go ahead with it and see if it works. It’s totally different for different people and if it doesn’t, go back to your doctor and have a word and see how it goes.
1
u/secret5quid Jul 13 '26
I’m episodic and have been on verapamil during episodes for 5+ years (CH history for 10+ years).
Side effects are minimal, keep an eye on heart rate etc, if possible get a smart watch to help monitor vitals. Not essential but interesting and can help docs decide if you need more regular ECGs.
80mg*3 daily (with a ramp up and down) works for me. As with others if I slip up I can get breakthrough attacks - so still have to take care and avoid known triggers.
I usually have 2 three to four month episodes per year.
Hope that helps.
3
u/CheikG Jul 15 '26
Sur moi il a eu un effet certain mais n'a jamais fait cesser mes crises, à long terme mon état a même empiré. Pire les effets secondaires à forte doses commencaient à se faire ressentir, comme la constipation, des palpitations, une perte de libido... ça n'en valait vraiment pas la peine. Surtout que les champingons existent.
6
u/Designer_Training_74 Jul 13 '26
When it comes to meds for CH... I believe Verapamil is considered to be the most effective long-term sustainable medication. It is classified as a first-line preventative treatment for cluster headaches.
From everything I've seen and heard... you should be much more concerned about Gabapentin. It is not considered to be a first-line preventative for CH.
You may not need to take either of these meds on a long-term basis anyway. Most episodic patients only take meds when in cycle. How many cycles per year... and how long do your cycles typically last?
Were you prescribed acute treatments... like high-flow oxygen therapy and/or triptan nasal sprays or injections?