Verapamil for Migraine Prevention

An Older Treatment With Doubtful Utility in Thwarting Migraines

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Experts believe that close to 14 million Americans should be on a migraine preventive drug—a medication that not only (theoretically) decreases the number of migraines, but also the severity and duration of migraine attacks.

The American Academy of Neurology and the American Headache Society consider the blood pressure medication verapamil a level U drug for migraine prevention, meaning these organizations believe (based on scientific findings) that for verapamil, "the evidence is conflicting or inadequate to support or refute the use of verapamil for migraine prevention." 

Despite this somewhat ambiguous recommendation, some neurologists and headache specialists continue to prescribe verapamil, mostly when other migraine preventive drugs have been exhausted.

Overview

Verapamil, available as the brand name Calan and Verelan in the United States, is a medication FDA-approved to treat high blood pressure, chest pain (called angina) and various heart rhythm problems. Verapamil is a calcium-channel blocker.  It's also used "off-label," meaning without FDA approval, for migraine prevention.

Verapamil is typically taken by mouth, available as a capsule or tablet, but it may also be given in solution form (by which it's given intravenously) for people in the hospital.

Research

Verapamil is not used very often anymore for migraine prevention, in large part, due to the lack of scientific proof that it is actually effective. Generally speaking, studies examining verapamil for migraine prevention either show that verapamil is not better than placebo in preventing migraines, or if a study does show a benefit (verapamil working better than placebo), the benefit is small.

In addition, the studies that show a small benefit in favor of verapamil over placebo have various methodology flaws (for example, too few patients in the study to draw any reliable conclusions).

Adverse Effects

Like all drugs, verapamil may cause adverse effects, some of which include:

  • Constipation
  • Headache
  • Flu-like symptoms
  • Swelling in the ankles and lower legs
  • Dizziness
  • Sore throat
  • Sinusitis

Warnings

When taking verapamil, it's imporant to be aware that serious problems may develop including heart failure, low blood pressure, an increase in liver enzymes, and heart arrhthymias. Be sure to seek out medical attention right away if you develop worrisome symptoms like problems breathing or fainting.

Keep in mind, these potential adverse effects and warnings are not meant to frighten you away from taking verapamil, as verapamil is generally a safe and well-tolerated drug. Instead, they are meant to make you knowledgeable about verapamil in the event your doctor prescribes it.

Contraindications

Verapamil is a pregnancy category C drug so should only be taken if the potential benefit outweighs the potential risk to the baby. Verapamil should not be used if a woman is breastfeeding.

People with various heart conditions should also not take verapamil. These include:

  • Low blood pressure
  • Sick sinus syndrome (except if a person has a pacemaker)
  • Second or third-degree heart block (except if a person has a pacemaker)
  • Atrial flutter or atrial fibrillation and an accessory bypass tract

Interactions

Be sure to inform your doctor of all medications you are taking (both prescription drugs and over-the-counter drugs), as well as any supplements, vitamins, or herbals.

Certain medications can interefere with verapamil and should not be taken concurrently. Likewise, other medications, like the cholesterol-lowering medications Zocor (simvastatin) and Mevacor (lovastatin), may require close monitoring by your doctor.

Lastly, discuss consumption of grapefruit juice and alcohol with your doctor if you are prescribed verapamil. Grapefruit juice may increase the level of verapamil in the bloodstream and verapamil blocks the elimination of alcohol in the body, leading to increased alcohol levels in the bloodstream.

A Word From Verywell

Due to the weak and conflicting scientific findings supporting verapamil as a migraine preventive drug, it is not commonly used anymore by neurologists or headache specialists.

Instead, other migraine preventive medications, like the ones listed as "effective," or "probably effective " by the AAN and AHS (for example, metoprolol), are likely tried out first before verapamil is considered.

Even then, there are emerging migraine preventive drugs, ones that block calcitonin gene-related peptide (CGRP), that will likely be tried before verapamil. This is hopeful news for the migraine community.

If you or a loved one is taking verapamil for migraine prevention, tolerating it well and its doing its job, than sticking with it is perfectly reasonable.

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