Case report: Prophylactic administration of verapamil for cluster headache during the pre-episode symptoms phase

As the first-line preventive treatment of cluster headache (CH), verapamil provides less relief in the initial stage of medication and takes 2-3 weeks to achieve optimal efficacy. Approximately one third of patients with CH have symptoms before the cluster period arrives, such as local pain, sensory abnormalities, and autonomic symptoms, which are called pre-episode symptoms (PES); however, no study has examined the role of prophylactic administration during this period.

Here, we report a patient with CH who was treated with verapamil at the beginning of the PES phase five times over 5 years to avoid the onset of CH. Unfortunately, CH recurred after the latest PES phase due to delayed treatment.

Prophylactic treatment in the PES phase of CH might reduce the severity or prevent the onset of headache during the episode phase, suggesting the feasibility of initiating prophylactic treatment in the PES phase. A large clinical trial is necessary to verify this.