Page 102 - Migraine, the heart and the brain

Chapter 6
round. (Questions e-table 2.). For continuous variables, mean values with ranges and standard deviations (SD) are presented, using SPSS, version 20, SPSS Inc., Chicago, IL, USA, for Windows.
results
Panel members reached consensus on one of six proposals (table 1) as 82% agreed that an EKG should be made prior to the rst dose of verapamil. Half the panel recommended to make EKGs during stable doses at set times, especially with mean daily doses of ≥ 330 mg (range: ≥ 120 - 480 mg). EKG before dose increase was recommended by 50% while 60% advised an EKG after dose increase. In total 45% recommended EKG both before and after dose increase. Those who advised EKG monitoring after dose increase, recommended doing this after an average of 5 days (range 1-14 days, SD 3.8). If patients were using ≥ 480 mg verapamil per day, ambulatory EKG Holter-monitor registration was recommended by 50% of the panel members. Most panel members deemed pretreatment EKG not necessary in patients who had had no cardiac adverse events while on verapamil during a previous period of cluster headache attacks.
Absolute contra-indications for continuation of verapamil treatment included: (1) bradycardia < 40 bpm (92% agreement); (2) 3rd degree AV block (86%); and (3) 2nd degree AV block Mobitz type (86%) (table 1). A 1st degree AV block (> 250 ms; was regarded as relative contra-indication (92%). For bradycardia <50 bpm and 2nd degree AV block Wenckebach type near consensus as relative contra-indications was reached (75% agreement).
Seventeen respondents recommended a mean maximal daily dose of 550 mg (range 240-960 mg). There was no preference for sustained- or regular-release formulations. (table 1).
Cardiologists from Europe and the United States did not differ with respect to their answers.
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