The effect of intravenous verapamil on cerebral hemodynamics in a migrainepatient with hemiplegia

OBJECTIVE: To describe the use of intravenous verapamil in a migraine patie nt with hemiplegia to reverse the symptomatology and hemodynamics of the mi ddle cerebral artery as determined by transcranial Doppler. CASE SUMMARY: A 31-year-old white woman was admitted with an acute exacerba tion of migraine with hemiplegia. A transcranial Doppler showed an increase d flow velocity through the middle cerebral artery consistent with a migrai nous process. The patient was treated with verapamil 5 mg iv and the hemipl egia gradually resolved. A transcranial Doppler indicated that the flow vel ocity through the middle cerebral artery was decreased after verapamil admi nistration, indicating reversal of the vasospasm. DISCUSSION: Transcranial Doppler has not been previously used to determine the effect of intravenous verapamil on the migrainous process. Intravenous verapamil reversed the altered hemodynamics of the middle cerebral artery a s determined by transcranial Doppler. This finding correlated with the grad ual resolution of hemiplegia. Whether both subjective and objective finding s in this patient can be attributed to the reversal of the cerebral artery hemodynamics is not known. CONCLUSIONS: Intravenous verapamil appears to reverse the vasospasm that ma y be associated with a migrainous process. Whether this effect is solely re sponsible for clinical improvement is not known. Verapamil may be a conside ration for the treatment of intractable migraine, especially when there is evidence of spasm of the major cerebral arteries.