Diltiazem Prophylaxis in Refractory Migraine

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Abstract
To the Editor: The beta-adrenergic antagonists propranolol1 , 2 and nadolol (Smith R: unpublished data), when given prophylactically, have been shown to reduce the frequency and intensity of headache in many patients with common or classic migraine.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. . . .

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