Verapamil and Cluster Headache: Still a Mystery. A Narrative Review of Efficacy, Mechanisms and Perspectives
Research output: Contribution to journal › Review › Research › peer-review
Standard
Verapamil and Cluster Headache : Still a Mystery. A Narrative Review of Efficacy, Mechanisms and Perspectives. / Petersen, Anja S.; Barloese, Mads C.J.; Snoer, Agneta; Soerensen, Anne Mette S.; Jensen, Rigmor H.
In: Headache, Vol. 59, No. 8, 2019, p. 1198-1211.Research output: Contribution to journal › Review › Research › peer-review
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Verapamil and Cluster Headache
T2 - Still a Mystery. A Narrative Review of Efficacy, Mechanisms and Perspectives
AU - Petersen, Anja S.
AU - Barloese, Mads C.J.
AU - Snoer, Agneta
AU - Soerensen, Anne Mette S.
AU - Jensen, Rigmor H.
PY - 2019
Y1 - 2019
N2 - 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.
AB - 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.
KW - calcitonin gene-related peptide
KW - calcium channel blockers
KW - chronobiology
KW - cluster headache
KW - preventive treatment
KW - side effects
U2 - 10.1111/head.13603
DO - 10.1111/head.13603
M3 - Review
C2 - 31339562
AN - SCOPUS:85069940222
VL - 59
SP - 1198
EP - 1211
JO - Headache
JF - Headache
SN - 0017-8748
IS - 8
ER -
ID: 236217352