Which of the following is a first-line preventive therapy for cluster headache?

Prepare for the Pharmacology IV – Headache Therapeutics Test. Review the therapeutic approaches, tackle multiple-choice questions with explanations, and boost your test-taking confidence. Ace your exam with precision!

Verapamil is the first-line preventive therapy for cluster headache because it has the strongest and most consistent evidence for reducing attack frequency when used as a prophylactic. It’s a calcium channel blocker that, at high daily doses, can significantly lessen how often clusters occur. Because of potential effects on heart conduction, starting the drug requires careful monitoring—an ECG is obtained before treatment and periodically during titration to watch for PR interval prolongation or heart blocks. If a patient cannot tolerate verapamil or does not respond adequately, alternatives exist (such as lithium, CGRP inhibitors, or short-term corticosteroids), but these have limitations like need for regular labs, cost, or side effects, and are typically considered after or alongside verapamil rather than as the initial choice.