Cardiac monitoring of high-dose verapamil in cluster headache: An international Delphi study

Koppen, Hille; Stolwijk, JA; Wilms, E.B.; Driel, Vincent van; Ferrari, Michel D.; Haan, Joost

doi:10.1177/0333102416631968

Cited by 15 publications

(9 citation statements)

References 11 publications

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“…This method has been widely used to develop clinical practice guidelines in other areas (e.g. endometriosis management [Schleedoorn et al, 2016], withdrawal of life-sustaining measures [Downar et al, 2016] and cardiac monitoring of high-dose verapamil in cluster headache [Koppen et al, 2016]). Australian & New Zealand Journal of Psychiatry, 51 4A particular advantage of using the Delphi method to develop this consensus statement is that equal value is given to the views of various categories of experts.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Royal Australian and New Zealand College of Psychiatrists expert consensus statement for the treatment, management and monitoring of the physical health of people with an enduring psychotic illness

Lambert

Reavley

Jorm

et al. 2017

Aust N Z J Psychiatry

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Royal Australian and New Zealand College of Psychiatrists expert consensus statement for the treatment, management and monitoring of the physical health of people with an enduring psychotic illness

Lambert

Reavley

Jorm

et al. 2017

Aust N Z J Psychiatry

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show abstract

“…They recommended that a pre-treatment ECG always be performed, but no consensus was reached on ECG monitoring during treatment. ECG before dose increase was recommended by 50%, whereas 60% recommended an ECG after dose increase [67].…”

Section: Verapamilmentioning

confidence: 99%

Pharmacotherapy for Cluster Headache

et al. 2020

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Cluster headache is characterised by attacks of excruciating unilateral headache or facial pain lasting 15 min to 3 h and is seen as one of the most intense forms of pain. Cluster headache attacks are accompanied by ipsilateral autonomic symptoms such as ptosis, miosis, redness or flushing of the face, nasal congestion, rhinorrhoea, peri-orbital swelling and/or restlessness or agitation. Cluster headache treatment entails fast-acting abortive treatment, transitional treatment and preventive treatment. The primary goal of prophylactic and transitional treatment is to achieve attack freedom, although this is not always possible. Subcutaneous sumatriptan and high-flow oxygen are the most proven abortive treatments for cluster headache attacks, but other treatment options such as intranasal triptans may be effective. Verapamil and lithium are the preventive drugs of first choice and the most widely used in first-line preventive treatment. Given its possible cardiac side effects, electrocardiogram (ECG) is recommended before treating with verapamil. Liver and kidney functioning should be evaluated before and during treatment with lithium. If verapamil and lithium are ineffective, contraindicated or discontinued because of side effects, the second choice is topiramate. If all these drugs fail, other options with lower levels of evidence are available (e.g. melatonin, clomiphene, dihydroergotamine, pizotifen). However, since the evidence level is low, we also recommend considering one of several neuromodulatory options in patients with refractory chronic cluster headache. A new addition to the preventive treatment options in episodic cluster headache is galcanezumab, although the long-term effects remain unknown. Since effective preventive treatment can take several weeks to titrate, transitional treatment can be of great importance in the treatment of cluster headache. At present, greater occipital nerve injection is the most proven transitional treatment. Other options are high-dose prednisone or frovatriptan.

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“…In an international Delphi study 40 cardiologists, who specialized in cardiac arrhythmias, had divergent opinions on how to monitor verapamil treatment . The only consensus recommendation made was to secure a baseline ECG before initiation of treatment.…”

Section: Side Effects and Safetymentioning

confidence: 99%

“…Furthermore, a pretreatment ECG was not deemed necessary in patients who had not suffered from cardiac side effects during a previous bout treated with verapamil. Half of the specialists recommended a Holter ECG when dosages exceeded 480 mg/day . American Headache Society and European Federation of Neurological Societies recommend ECG monitoring …”

Section: Side Effects and Safetymentioning

confidence: 99%

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

et al. 2019

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Objective A evaluation of the effect of verapamil and other calcium channel blockers in cluster headache (CH) treatment and an investigation of possible effect mechanisms. Background Verapamil has been used in the prevention of CH for almost 3 decades, however, the mode of action and therapeutic target is still unknown. Methods A Pubmed search was conducted: “Verapamil”[Mesh] and “Cluster Headache”[Mesh]. We identified 5 relevant studies for CH. 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. Results Clinical effect: Clinical preventive treatment of CH with verapamil is based on 2 randomized controlled studies and 3 open‐label studies. In total, 183 CH 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 release of calcitonin gene‐related peptide. Conclusion 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. 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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Cardiac monitoring of high-dose verapamil in cluster headache: An international Delphi study

Abstract: Experts in cardiac rhythm disorders agreed on pretreatment EKG monitoring, but no consensus was reached on EKG monitoring during HDV treatment and around dose adjustments.

Cited by 15 publications

References 11 publications

Royal Australian and New Zealand College of Psychiatrists expert consensus statement for the treatment, management and monitoring of the physical health of people with an enduring psychotic illness

Royal Australian and New Zealand College of Psychiatrists expert consensus statement for the treatment, management and monitoring of the physical health of people with an enduring psychotic illness

Pharmacotherapy for Cluster Headache

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

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