Drug	Dosage and route of administration	Adverse effects	Comments
Verapamil	Minimum of 240 mg orally per day, insingle or divided doses	Abdominal discomfort,bradycardia, constipation,edema, gum hyperplasia,hypotension	Electrocardiography required to monitorfor prolonged PR interval, change incardiac axis, or broadening of QRS
Steroids	50 to 80 mg of oral prednisone per day, tapered gradually over 10 to 12 days	Hyperglycemia, hypertension, increased appetite, insomnia, nervousness	May be useful for bridging therapy; no adequate randomized controlled trials are available18
	Suboccipital injection: 12.46 mg of betamethasone dipropionate plus 5.26 mg of betamethasone disodium phosphate plus 0.5 mL of lidocaine (Xylocaine), 2%	Transient injection site pain
Valproic acid (Depakene)	600 to 2,000 mg per day	Alopecia, anorexia, dizziness, insomnia, nausea, somnolence, suicidal ideation, thrombocytopenia, weakness, weight gain	Use with caution in patients with renal or hepatic insufficiency; can be used with sumatriptan (Imitrex)
Topiramate (Topamax)	25 mg orally for seven days, then increase by 25 mg per day every week to a maximum of 400 mg per day	Dizziness, paresthesias, slow speech; mostly well tolerated	Contraindicated in patients with nephrolithiasis
Ergotamine	3 to 4 mg orally per day in divided doses for up to three weeks; maximum of 6 mg per day or 10 mg per week; give 30 to 60 minutes before anticipated headaches or at bedtime for nocturnal cluster headache	Angina, fibrosis (cardiac valvular, retroperitoneal, pleuropulmonary), myocardial infarction, pruritus, vertigo	Contraindicated in patients with peripheral vascular disease, hypertension, or cardiac disease; use with caution in patients with renal or hepatic insufficiency; should not be taken within 24 hours of a triptan; withdrawal is possible if abruptly stopped
Melatonin	10 mg orally at bedtime	None	—
Capsaicin	Intranasal application three or four times per day	Local irritation	—