Sustained Release Verapamil Survey

Please take a moment to complete this survey about your experience with using Verapamil SR as a preventative for cluster headaches.

The results of this survey will be shared with medical professionals to help them prescribe the correct treatment for their cluster patients.

If you don't see some of your answers on the "Results" page, don't worry, you completed the survey correctly. Some answers cannot be shown because of the way the program operates. Your responses were received and will be used when we analyze the results.
1. What is your sex? female
male
2. What year were you born? year of birth
3. Are your clusters episodic or chronic? episodic
chronic
4. What dose of Verapamil did you take? 120mg / day
 240mg / day
 360mg / day
 480mg / day
 600mg / day
 720mg / day
 840mg / day
 960mg / day
5. What, if any, was the worst side effect you experienced? constipation
 dizziness
 nausea
 hypotension (low blood pressure)
 edema (fluid retention, swelling)
 fatigue
none
other
6. Were you taking any other preventative medications such as lithium, topamax, prednisone, etc. at the same time you were taking verapamil? yes
name of medication
no
7. Did it stop your headaches? Yes
 No (skip to question #9)
8. If it stopped your headaches, how long did it take to become effective? 1 week or less
 1-2 weeks
 2-3 weeks
 3-4 weeks
 more than 4 weeks
NA
You are done! Go to the bottom of the survey, enter optional information and submit.
9. Did it reduce the frequency or intensity of your headaches? frequency
intensity
both
neither (skip to "Optional Information" at the bottom of the form)
NA
10. How long did it take to reduce the frequency or intensity of your headaches? 1 week or less
 1-2 weeks
 2-3 weeks
 3-4 weeks
 more than 4 weeks
NA
11.  How much did it reduce the frequency of your headaches? 25% or less
25-50%
50-75%
75-99%
NA
12.  How much did it reduce the intensity of your headaches? 25% or less
25-50%
50-75%
75-99%
NA
Optional Information
E-mail Address
Comments: