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More than 4 million people experience chronic migraine — having 15 or more migraine days per month.

Verapamil isn’t a primary option for migraine treatment or prevention. There are more effective treatment and prevention options available, and it’s unlikely that a doctor will prescribe this medication for migraine.

Keep reading to learn more about verapamil and why it was once used for migraine.

Verapamil belongs to a group of medications called calcium channel blockers. These medications are mainly used to manage high blood pressure.

They work by relaxing blood vessels, allowing blood to flow more freely to the heart. This helps lower blood pressure.

In the past, verapamil was also prescribed to treat cluster headaches and prevent migraine. However, it’s not Food and Drug Administration (FDA)-approved for these conditions, so it was considered an off-label treatment for them.

“Off-label” means that a medication is used for another reason or dose than it was approved. This is a common practice.

Migraine preventive medications are different from rescue treatment medications. Preventive migraine medications help lower the number of overall monthly attacks, how long they last, and the severity of migraine attacks.

Doctors previously thought increased pressure in blood vessels might cause migraine attacks, and this is one reason verapamil was prescribed.

There’s weak evidence for verapamil’s effectiveness for migraine prevention. That’s why it’s not the first option doctors choose.

The Canadian Headache Society guidelines for preventive treatment of migraine offer a weak recommendation for verapamil. The American Family Physicians guidelines also state that verapamil has little evidence of effectiveness for migraine prevention.

Verapamil is used to treat cluster headaches. A 2019 review study of verapamil for cluster headaches showed that it’s effective for this type of headache attack. A verapamil dose of 360 milligrams (mg) per day helped half the people with chronic cluster headaches. And those with episodic cluster headaches had one less attack per day with verapamil.

Read this article for more information about migraine.

Pros of verapamil for migraine

  • available as an oral medication in different forms (capsule, tablet)
  • available as generic (inexpensive)
  • effective for cluster headaches
  • may help people with high blood pressure and headaches, particularly cluster headaches

Cons of verapamil for migraine

  • shows little evidence of effectiveness for migraine prevention
  • may take several weeks to work, if it works at all
  • has some serious side effects (low blood pressure, heart related problems)
  • requires regular use rather than just when a migraine attack occurs
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Verapamil is available in several dosage forms and strengths in brand and generic. Brand names include Calan, Calan SR, Verelan, and Verelan PM.

It comes in immediate release, extended release, and delayed release in capsule and tablet forms.

The dosage of verapamil depends on:

  • the reason for its use
  • other health conditions you may have
  • other medications you take
  • your age

Your doctor will start you on the lowest dose to provide maximum benefits with the least risks.

You can take the extended release type of verapamil with or without food. Don’t split, crush, or chew the extended release capsules. You can cut the extended release tablets, but don’t crush or chew them.

Read this article for tips on swallowing pills.

For use in migraine prevention, doses can vary. Doses may range from 120 mg to 480 mg. Your doctor will start you on the lowest effective dose to prevent migraine and increase the dose gradually as needed till you get relief.

It may take several weeks for it to work, so be patient with your treatment plan. Ask your doctor how long it may take for verapamil to start working.

In clinical studies of verapamil use for cluster headaches, the dose used was 360 mg per day.

Verapamil has some side effects. For most people, these are mild and go away with regular use.

But some people can experience serious side effects with verapamil. If you experience a serious or life threatening reaction to verapamil, call 911 or get to an emergency medical center immediately.

This is not a complete list of all the possible side effects and interactions of verapamil. Your doctor or pharmacist can provide more information about all the side effects and interactions of verapamil.

Common side effects

People may experience more common side effects of verapamil, including:

  • constipation
  • cough
  • headache
  • low blood pressure
  • drowsiness

Serious side effects

Some people may experience serious side effects when taking verapamil. These side effects include:

  • difficulty breathing
  • dizziness or light headedness
  • fainting
  • changes in heart rhythm, palpitations, or chest pain
  • skin rash
  • swelling of your legs or ankles

Drug interactions

Verapamil may interact with other drugs you take. These interactions may include:

Verapamil can also interact with foods, vitamins, and other over-the-counter products. Tell your doctor about all your medications and over-the-counter products you take.

Do not take verapamil with grapefruit juice. It can slow the removal of verapamil from your body causing the drug to build up. This can increase your risk of serious side effects.

Reasons verapamil may not be right for you:

  • You have migraine. The evidence is weak that verapamil actually prevents migraine, and there are far more effective medication options.
  • You have elevated liver enzymes. Verapamil may raise liver enzyme levels in some people. Symptoms include fatigue, fever, pain in the right upper area of your belly
  • You have heart rhythm problems. If you have certain heart rhythm problems, verapamil may not be right for you. Your doctor will discuss risks and benefits of the medication.
  • You drink alcohol. Drinking alcohol with verapamil can increase side effects of the drug and the effects of alcohol on your body. Ask your doctor about drinking alcohol if you’re taking verapamil.
  • You’re pregnant. Verapamil may not be safe if you’re pregnant. Ask your doctor about the risks of verapamil during pregnancy.
  • You’re breastfeeding. Verapamil does pass into breast milk. Ask your doctor whether it’s safe to breastfeed if you’re taking verapamil and alternative options to consider.
  • You’ve had an allergic reaction to it. Verapamil can cause an allergic reaction. Don’t take the medication if you’ve had an allergic reaction to the drug. Symptoms include rash, itching, difficulty breathing, swelling of lips, tongue, or mouth.
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Yes, you can overdose on verapamil. Taking too much verapamil can cause serious, even life threatening reactions.

Serious symptoms from overdose include:

  • very low blood pressure
  • problems with heart rhythm
  • kidney problems
  • convulsions
  • slow heart rate

Take the exact dose of verapamil your doctor prescribes. Don’t increase your verapamil dose on your own.

Call Poison Control at 1-800-222-1222 if you think you’ve taken too much verapamil. For a life threatening medical emergency, call 911 or go to an emergency medical center immediately.

Today there are plenty of choices to both prevent migraine from happening and treat acute symptoms.

Verapamil doesn’t show strong evidence of effectiveness for migraine prevention. A review of studies showed that verapamil didn’t reduce migraine episodes compared to placebo.

The American Family Physician recommends other medications as first choice options for migraine prevention with good evidence of effectiveness.

Read this for a detailed explanation of medications used to treat migraine.

Verapamil doesn’t have strong evidence of effectiveness for use in migraine prevention. There are other medications that are better, so it’s not generally the first option considered.

Your doctor may discuss verapamil if other treatments haven’t worked or if you also have high blood pressure with migraine.

Learn about what triggers your migraine attacks (environmental, dietary, behavioral) and develop steps to avoid them.

Examples of migraine triggers include:

  • stress
  • sleep problems
  • scents
  • certain foods
  • hormonal changes
  • weather changes

Ask your doctor about other medications and lifestyle support options for migraine like cognitive behavioral therapy, yoga, biofeedback, relaxation training, and acupressure that might help with your symptoms.