Page 108 - Migraine, the heart and the brain

Chapter 6
7. What is the maximum daily dose of verapamil to prescribe in the given case?
240 mg / 320 mg/ 400 mg/ 480 mg/ 560 mg/ 640 mg / 720 mg/ 800 mg/ 880 mg/ 960 mg / 1040 mg/ 1120 mg
8. Verapamil controlled release (retard, sustained release) should be used instead of normal (short acting) verapamil
Strongly disagree Disagree Neutral Agree Strongly agree
9. When on a verapamil dose of 480 mg/day (or higher), a 24-hour holter EKG is to prefer over an normal EKG. Strongly disagree Disagree Neutral Agree Strongly agree
10. In the given case, after 3 months of daily dose of 480 mg Verapamil, the current cluster headache episode has ended and Verapamil could be discontinued. After six months, however, cluster attacks recurred resulting in a new indication for verapamil (start dose 80 mg 3dd1).
Should a EKG be made prior to restart (considering that all previous EKGs were normal)?
Strongly disagree Disagree Neutral Agree Strongly agree
11. Additional comments (if any):
12. Do you use a local or national guideline on verapamil use? Yes / No
If Yes: Local or National
Summary of consensus reached in first Delphi round:
An EKG should be made prior to a rst verapamil prescription of 80 mg 3dd1 81,8% agreed
Which EKG abnormalities are absolute criteria for discontinuation of verapamil? (open question) AV III was answered by 86,4%
AV II Mobitz was answered by: 86,4 %
For the remaining answers no consensus (de ned as least 80 % agreement) was reached.
Please answer questions of this second Delphi questionnaire round.
Again the same case vignette applies to all questions:
Case vignette.
A cluster headache patient without cardiac history, with normal blood pressure.
No cardiac complaints (asymptomatic patient) . No cardiovascular co-medication. There is an indication for cluster headache treatment with verapamil.
• AV II Wenkenbach block is an absolute contra-indication for start or continuation of verapamil Strongly disagree Disagree Neutral Agree Strongly agree
• Asymptomatic bradycardia of 50 bpm or less is an absolute contra-indication for start or continuation of verapamil
Strongly disagree Disagree Neutral Agree Strongly agree
• Asymptomatic bradycardia of 40 bpm or less is an absolute contra-indication for start or continuation of verapamil
Strongly disagree Disagree Neutral Agree Strongly agree
• Sinuspause > 3 seconds is an absolute contra-indication for start or continuation of verapamil Strongly disagree Disagree Neutral Agree Strongly agree
• Sicksinus syndrome is an absolute contra-indication for start or continuation of verapamil Strongly disagree Disagree Neutral Agree Strongly agree
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