Migraine and Cluster Headache Treatment With Calcium Antagonists Supports a Vascular Pathogenesis

Meyer, John Stirling; Nance, Matthew; Walker, Mary; Zetusky, Walter J.; Dowell, Richard E.

doi:10.1111/j.1526-4610.1985.hed2507358.x

Cited by 40 publications

(23 citation statements)

References 16 publications

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“…β‐Blockers are thought to interact with 5‐hydroxytryptamine (5‐HT) or serotonin receptors and cross‐modulation of the serotonin system 1 . Calcium channel blockers block intracellular calcium entry and cellular depolarization 2,3 . Tricyclic antidepressants block reuptake of 5‐HT at central sites 4,5 .…”

mentioning

confidence: 99%

Use of a Pine Bark Extract and Antioxidant Vitamin Combination Product as Therapy for Migraine in Patients Refractory to Pharmacologic Medication

Chayasirisobhon

2006

Headache

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mentioning

confidence: 99%

Use of a Pine Bark Extract and Antioxidant Vitamin Combination Product as Therapy for Migraine in Patients Refractory to Pharmacologic Medication

Chayasirisobhon

2006

Headache

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“…14 Hemodynamic and clinical observations during treatment with calcium antagonists support the Wolff hypotheses that abnormal cephalic vascular control mechanisms are responsible for the head pain in cluster headache. 15 In our patient epilepsy and cluster headache coexist. To our knowledge, no similar case has been reported.…”

Section: Discussionmentioning

confidence: 58%

Cluster Headache and Intercalated Seizures in a Young Man: Therapeutic Effectiveness of Flunarizine

1989

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A young man suffering from both cluster headache and epilepsy is reported. Since the age of 37 he had recurrent generalized tonic-clonic seizures; one year later cluster headache attacks began. Neurological examination, standard laboratory tests and CT-scan were normal. The EEG showed medium-voltage sharp waves, not blocking upon eye opening, over the right parieto-temporal region. Flunarizine was added to his phenytoin therapy; it controlled both paroxysmal disorders. After six months, flunarizine was discontinued and during a one year follow-up the patient remained symptom-free. This calcium channel blocker can be regarded as an ideal drug in patients suffering from both cluster headache and epilepsy; it controls this headache syndrome and is a useful add-on to standard anti-convulsant therapy.

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“…Other observations indicated that calcium antagonists act via a mechanism which is not only vascular. Variations in regional cerebral blood flow and cerebrovascular response to various stimuli were monitored in groups of CH and migraine patients while undergoing treatment with calcium antagonists [20, 21]. Results showed that verapamil was more efficacious than other calcium antagonists in treating CH, but induced minimal changes in cerebral circulation which, in any event, were less than those produced by other calcium antagonist drugs.…”

Section: Discussionmentioning

confidence: 99%

High-Dose Verapamil in Episodic and Chronic Cluster Headaches and Cardiac Adverse Events: Is It as Safe as We Think?

Alexandre

Humbert

Sassier

et al. 2015

Drug Saf - Case Rep

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Cluster headache (CH) is a primary headache disorder with relatively effective treatments. Although few sufficiently controlled trials are available, verapamil is recommended as the first-line prophylactic drug for CH by the French Headache Society (with a low level of evidence, level B) and by the EFNS (European Federation of Neurological Societies, level A). Daily doses of more than 480 mg (and up to 1200 mg daily) are frequently used off-label, while 360 mg daily is the only dosage to have demonstrated its effectiveness in a double-blind trial against placebo, and the usual label posology used by cardiologists is 240 mg daily in hypertension. We report the case of a 19-year-old man who was self-reported to our cardiology consultation for dyspnea and asthenia for 18 months. His medical history consisted of CH crisis for 4 years treated by verapamil 720 mg/day for 18 months with relatively good efficiency. His electrocardiogram (ECG) showed a sinus bradycardia at 40 bpm with a first-degree atrio-ventricular block. Evolution was favorable after progressive verapamil discontinuation. Analysis performed on the French Pharmacovigilance Database between July 1, 2000 and December 1, 2014 found four other cases of cardiac adverse events related to high-dose verapamil used in CH prevention (two cases of syncope with complete atrio-ventricular block with verapamil 1200 and 240 mg daily, respectively, one syncope related to sick sinus syndrome with verapamil 360 mg daily, and one case of sinus bradycardia with verapamil 720 mg daily). 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.

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Migraine and Cluster Headache Treatment With Calcium Antagonists Supports a Vascular Pathogenesis

Cited by 40 publications

References 16 publications

Use of a Pine Bark Extract and Antioxidant Vitamin Combination Product as Therapy for Migraine in Patients Refractory to Pharmacologic Medication

Use of a Pine Bark Extract and Antioxidant Vitamin Combination Product as Therapy for Migraine in Patients Refractory to Pharmacologic Medication

Cluster Headache and Intercalated Seizures in a Young Man: Therapeutic Effectiveness of Flunarizine

High-Dose Verapamil in Episodic and Chronic Cluster Headaches and Cardiac Adverse Events: Is It as Safe as We Think?

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