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High-Dose Verapamil for Cluster Headache May Pose Arrhythmia Risk

Charles Bankhead
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. | August 13, 2007

Tell interested patients that use of verapamil to prevent cluster headache was associated with cardiac arrhythmias in almost 20% of cases.
Emphasize that verapamil doses used to prevent cluster headache are usually much higher than those used for cardiovascular purposes.
Also note that the study was based on a chart review, and data on many patients were missing.

LONDON, Aug. 13 -- Headache patients receiving prophylactic high-dose verapamil(Drug information on verapamil) face a risk of heart rhythm disturbances that warrants EKG monitoring of all patients on the therapy, investigators have concluded.

Arrhythmias occurred in 19% of patients with cluster headache receiving prophylactic doses of verapamil as high as 1200 mg a day, Peter J. Goadsby, M.D., Ph.D., D.Sc, of the Institute of Neurology here, and colleagues, reported in the August issue of Neurology.

Additionally, they said, 36% of patients had episodes of bradycardia.

"This study highlights the need for careful EKG monitoring of patients with [cluster headache] while on verapamil," the authors concluded. "EKG abnormalities could occur even at the lower doses of 240 mg daily, so it would be insufficient only to perform EKGs at higher doses."

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