Hello, need help with next management.
61 yo man with hx of depression with headaches for a month, .
He has been having headaches for about a month or so, starting near Jan 2020.
The headaches start in the left eye like a burning sensation and then spreads out over the rest of the face as the day goes on, as a stabbing or burning. Previously, they would start in the left eye as well. They can last for hours, sometimes all day, esp if he does not take anything. There are no auras. No numbness/weakness in his arm/legs.
Since starting, they have been daily. They do not interrupt his sleep.
He notices that Xanax helps the headache away with a milligram, but returns 4-5 a day. He tried rizatriptan but did not find it helpful.
He does not have nausea but there is photo/phonophobia. No autonomic symptoms, but has chronic rhinnorrhea from allergies.
I tried Emgality which helped for a month but then the symptoms wore off and in the second and third month, the headaches began to return.
He has had a sinus work up, MRI, EEG was negative. Topamax was not helpful.
Should I try verapamil as a cluster variant or a migraine preventive?