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Second-Line Chronic Daily Headache (CDH)
Prevention Medications
Posted Jan 1999

  1. Beta-blockers: Occasionally useful for daily headache and very effective for migraine. Often combined with tricyclics or anti-inflammatories. Propranolol (Inderal) and nadolol (Corgard) are commonly used. Fatigue, depression, lower GI cramps, and weight gain may occur. Doses are similar to those used for migraine.

  2. Muscle relaxants:
    Safe but only mildly effective; some patients do respond well to these. Fatigue is a prominent side effect. Cyclobenzaprine (Flexeril) is one of the most effective, but may cause severe fatigue. Orphenadrine (Norflex) is effective for some patients. It is best to utilize nonaddicting muscle relaxants.

  3. Calcium channel antagonists: (Verapamil)
    Occasionally effective for daily headache as well as migraine and cluster. Verapamil (Calan, Isoptin, Veralan) is the most effective calcium blocker. The SR tablets allow once per day dosing. Constipation and allergic reactions (with a rash) are common. May be combined with tricyclics or anti-inflammatories.