Diltiazem Prophylaxis in Refractory Migraine

Abstract

To the Editor: The beta-adrenergic antagonists propranolol^{1 , 2} and nadolol (Smith R: unpublished data), when given prophylactically, have been shown to reduce the frequency and intensity of headache in many patients with common or classic migraine. However, these drugs are contraindicated in patients with asthma, heart block, or insulin-dependent diabetes³; and they can also produce undesirable side effects in other patients.⁴ There are patients whose migraine headaches are resistant to beta-blockers, and there is a troublesome subgroup of patients with "refractory" migraine — i.e., a long history of common or classic migraine followed by daily headaches with frequent severe exacerbations. . . .