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Cluster Headache – Verapamil ECG Monitoring — SCE Neurology MCQ

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HardHeadache & Facial PainCluster Headache – Verapamil ECG MonitoringSCE Neurology

A 32-year-old with episodic cluster headache has a normal baseline ECG and starts verapamil 80 mg three times daily. Dose increments are planned at two-week intervals because attacks persist. Which surveillance strategy is most appropriate during titration?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Repeat a 12-lead ECG after every planned verapamil dose increment

High-dose verapamil used for cluster-headache prevention can prolong PR conduction and cause atrioventricular block, sometimes after a previously tolerated dose. BASH advises a baseline ECG and repeat ECG surveillance every two weeks during escalation; many clinicians perform it before each increment. Blood-pressure review is useful but does not replace conduction assessment, while serial echocardiography, drug concentrations and biochemical panels do not detect the principal titration hazard.

Reference: BASH guideline: cluster headache (BASH guideline version 2.0, current in 2026): https://bash.org.uk/2-4-1-cluster-headache/