migraine and calcium antagonists

Last edited 05/2021 and last reviewed 05/2021

Calcium antagonists are widely used in the treatment of migraine in other countries, but are not licensed in the UK for migraine.

Flunarizine is probably the most effective, but it is not available in the UK. Verapamil is an alternative (1).

In general, calcium antagonists may decrease the frequency of attacks but have little effect on their severity.

In the UK NICE suggest with respect to cluster headaches (2):

  • consider verapamil for prophylactic treatment during a bout of cluster headache. If unfamiliar with its use for cluster headache, seek specialist advice before starting verapamil, including advice on electrocardiogram monitoring (in November 2015, this was an off-label use of verapamil).
  • seek specialist advice for cluster headache that does not respond to verapamil.


  1. Evidence Based Medicine 1997; 2(6): 184.
  2. NICE (May 2021). Headaches in the over 12s