What dose will I take to prevent migraines?
An optimal dose means a dose of Verapamil that is effective in preventing your migraines, with little to no side effects. Normally this involves starting at the lowest possible dose, and increasing the dose gradually, a process often called titrating.
Taking a dose higher than an appropriate dose for you is unlikely to be of further benefit for migraine prevention, and is more likely to lead to side effects.
Titrating to an optimal dose varies from person to person. There are two principles to follow
- Go slow! Only ever increase the dose by 120 mg.
- Continue at a dose for two weeks before increasing.
Every person is different, and some patients respond well to lower doses of medication than others. Conversely, some patients will need to increase their medication to a higher dose before experiencing benefit. For others there may be side effects which are usually temporary, but may slow down the process of increasing the medication dose.
The highest dose that is tolerated is the optimal dose. Titration is simply the process of cautiously increasing a medication dose from a low starting dose, so that side effects can be avoided, treated or minimized. Below are standardized titration guidelines for Verapamil.
What is the starting dose?
The initial dose is 120 mg once daily, i.e. one tablet of 120 mg Verapamil. As Verapamil can often cause some mild side effects, it is recommended to take the first dose in the evening, ie just before you go to sleep.
After taking the first tablet, it might be helpful to note whether you experience any side effects in your headache diary. Monitoring your migraines, and the timing and character of any side effects from Verapamil, may help you work out your ideal dose more easily.
How do I increase my dose?
Every two weeks review whether you are having fewer migraines, and whether you are having side effects.
If the initial dose is tolerated for two weeks, and you are yet to see the full benefit of treatment (prevention of migraines) it is recommended to increase the dose by 120 mg.
It is better to take too little, than too much.
With medication, the higher the dose you take, the higher the amount of medication is in your system, and the higher the chance of experiencing side effects. Whilst there is a maximum dose of 240 mg per day, many patients have excellent prevention of migraines at 120 mg per day. Sometimes what seems like a small dose increase, may mean significantly more side effects.
How do you know if your treatment is working?
Put on the spot, it is often difficult to compare before and after taking medication! We recommend keeping a migraine diary. Record the number of migraines headaches that you experience each week, and their intensity. Also make a note of all medications, and supplements that you are taking. It may also help to record any side effects that you are experiencing.
You may notice benefits directly such as fewer headaches occurring, or less intense headaches that are more easily relieved with acute drugs. You may notice more benefit from other techniques that you use to make yourself comfortable during a headache (such as lying down or sleeping, going to a dark and quiet place).
Alternatively you may feel the benefits in other ways: you may feel more rested, or notice an improvement in sleeping patterns, it might be that you feel more productive at work or at home, or you feel able to take part in more family, social or leisure activities.
Remember you may only notice a difference in your migraines after consistently taking your medication at the optimal dose for at least three months.
How do I know what dose of medication to stop at?
The dose that is right for you may be the maximum dose, or a lower dose. Taking a higher dose doesn't always mean more benefits as it is different for everyone.
A positive end point would be a dose where you meet the following three criteria:
- Fewer headaches occurring (compared to baseline and at least one day per week less).
- Experiencing less intense headaches.
- Acute drugs now work better for your headache.
If you increase a dose and experience intolerable side effects, it is likely you are taking a dose that is higher than your ideal dose. In this situation, stop taking the higher dose and continue at the previous dose. It is unlikely that there will be any significant benefit by persisting with intolerable side effects.
- Begin the treatment by taking an initial dose of 120 mg per day of Verapamil, ie one tablet of 120 mg Verapamil.
- Every two weeks review whether you are having fewer migraines, and whether you are having side effects. If you are yet to see the full benefit of treatment (prevention of migraines) increase the dose by 120 mg after two weeks. But do not take more than 240 mg in a 24 hour period, ie two tablets of 120 mg Verapamil.
- If you increase a dose and experience intolerable side effects, stop taking the higher dose and continue at the previous dose.
- Continue taking this treatment for at least three months to see benefits in migraine frequency and intensity reduction.