Anatomy of a Headache

Dr. Robbins Free Medical
Radio Podcasts



Long-Acting Opioids for
Refractory Chronic
Migraine

Study results for a group
of difficult-to-treat
migraineurs provide a
basis for determining
efficacy and guidelines
for the use of long-term
opioids in this
population.

 

Heatherís Chronic
Migraine: an Interactive
Case History

This column will take you,
step by step, through
the diagnosis of a complex
headache patient with
the pseudonym of "Heather."

 

ROBBINS HEADACHE CLINIC

60 Revere Drive, Suite 330, Northbrook, IL 60062
Phone: 847-480-9399

Title:
Double Blind Comparison of Lithium and Verapamil in Cluster Headache Prophylaxis
Author:
Bussone G, Leone M, et al.
Date:
Posted: January 2010
Source:
Headache  30:411-417, 1990

Chronic Cluster Headache (CCH) treatment is troublesome; since there are no pain-free periods, it must be continuous. The most effective CCH prophylactic drug today is lithium carbonate but long-term use of this drug is limited by the possibility of side effects. Recently, calcium antagonists have been successfully employed to prevent migraine, and preliminary studies also indicate that verapamil in particular is an efficacious treatment for CCH. We have conducted a multicenter trial employing a double-dummy, double blind, cross-over protocol, comparing verapamil with the established efficacy of lithium carbonate, in preventing CCH attacks. Both lithium carbonate and verapamil were effective in preventing CCH but verapamil caused fewer side effects and had a shorter latency period. We did not observe any correlation between plasma levels of the two drugs and their clinical efficacy. Both the drugs tested here may exert their effect by restoring a normal inhibitory tone to the pain modulating pathways from the trigemino-vascular system, a circuit putatively implicated in CCH.

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