Before initiating verapamil for cluster headache prophylaxis, which assessment is required?

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Multiple Choice

Before initiating verapamil for cluster headache prophylaxis, which assessment is required?

Verapamil can slow the heart’s electrical conduction, especially at higher doses used for cluster headache prophylaxis. Because its major safety concern is bradycardia or AV block, a baseline electrocardiogram is essential to assess the heart’s rhythm and conduction before starting therapy and to monitor during dose titration. If the ECG shows preexisting conduction delay or if bradycardia develops, the treatment plan should be adjusted. A brain MRI is not required specifically to initiate verapamil, and routine liver function tests or CBCs don’t predict or mitigate the main risk of this drug. Baseline ECG therefore best addresses the key safety concern.

Verapamil can slow the heart’s electrical conduction, especially at higher doses used for cluster headache prophylaxis. Because its major safety concern is bradycardia or AV block, a baseline electrocardiogram is essential to assess the heart’s rhythm and conduction before starting therapy and to monitor during dose titration. If the ECG shows preexisting conduction delay or if bradycardia develops, the treatment plan should be adjusted. A brain MRI is not required specifically to initiate verapamil, and routine liver function tests or CBCs don’t predict or mitigate the main risk of this drug. Baseline ECG therefore best addresses the key safety concern.

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