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Verapamil is a difficult drug in any context. As a calcium channel blocker it was originally used as an anti-hypertensive and in some irregular heart rhythms. It was never a very good blood pressure medication and the number of abnormal rhythms it contributed to were worse that those it was intended to treat. When Beta blockers gained popularity in preventing migraines calcium channel blockers were also tried but with less success. Verapamil shows up as the number one phama drug to prevent attacks but that recommendation has surprisingly little evidence to support its use and effectiveness. {I have attached a link to a(nice article at the bottom of this post) My personal experience was taking 1200mg a day and getting so constipated even if it worked I'm not sure it would have been worth it. Over the years one gets a general feel how fellow cluster heads are doing with conventional treatment. This of course is tempered by the reality most folks enjoying successful treatment don't stick around or follow up. I never ever get a YES this stuff works impression. Doses are often too small, the length of use wasnt enough or the side effects not tolerated. My opinion is it is very much a something to try drug but won't be too hopeful. Steroids can be very helpful but those too are often under-dosed , taken long enough or transitioned to something that might give long term relief. All these things are super hard because no doctor who doesn't deal with this curse can appreciate the exquisite, intense and debilitating pain this condition offers. Since for most the attacks are episodic there is never a deliberate treatment plan worked out. In the end its up to the individual to muster all their resources and direct care with an understanding caregiver to deal with this horror. https://americanheadachesociety.org/news/verapamil-cluster-headache/