Page 103 - Migraine, the heart and the brain

Table 1. Results of Delphi questionnaire Propositions
Need for EKG
1. Prior to start of verapamil
2. At set times during stable dose
If not necessary at all doses, cut off dose(mean) 3. Prior to dose increase
4. After dose increase
5. Holter EKG ≥ 480 mg/day verapamil
6. Before restart when previously no side effects
EKG absolute contra-indications
Bradycardia < 40 bpm (asymptomatic) 3rd degree AV block
2nd degree AV block, Mobitz type Sinus pause > 3 seconds
2nd degree AV block Wenckebach type Sick sinus syndrome
1st degree AV block but < 250 ms Re-entrant tachycardia
Asymptomatic bradycardia < 50 bpm
EKG relative contra-indications
1st degree AV block > 250 ms
New junctional rhythm
Asymptomatic bradycardia < 50 bpm 2nd degree AV block, Wenckebach type Bradycardia < 40 bpm (asymptomatic) New bundle branch Block
Verapamil
Sustained release preferred
Highest daily dose to prescribe (mean)&
*Percentage of agreement in second Delphi round.
& Only answered by n=17.
Answers with 5% agreement or lower not included in table
disCussion
Agreement by cardiologists
82%
50%
330 mg/day 50%
60%
50%
23%
92% * 86% 86% 69% * 69% * 46% * 31% * 23% * 8%*
92% * 6 77% *
75% *
75% *
50% * 31% *
52%
550 mg (range 240-960)
Cardiac monitoring of high dose verapamil in cluster headache
We used the Delphi approach to de ne recommendations from cardiologists specialized in rhythm disorders for safe use and EKG monitoring of HDV in cluster headache. The panel members agreed on performing a pretreatment EKG in patients using verapamil for the rst time. Pretreatment EKG was deemed not necessary in patients who did not have cardiac adverse events during a previous period of cluster
101