Which treatment is used as prophylaxis in cluster headache management?

Verapamil is the correct choice for prophylaxis in managing cluster headaches, a condition characterized by recurrent, severe unilateral pain that can occur in cycles. This calcium channel blocker is primarily used to prevent the occurrence of cluster headache attacks rather than to treat them once they emerge.

In cluster headaches, the attacks can be disabling and occur in clusters over weeks to months, followed by periods of remission. Prophylactic treatment aims to reduce the frequency and intensity of these headache episodes. Verapamil helps to stabilize the electrical activity of neurons and may act on the hypothalamus, the area of the brain implicated in the regulation of circadian rhythms associated with cluster headache attacks.

Other options do have roles in headache management but are not suitable for prophylaxis in cluster headaches. Sumatriptan is effective for terminating acute attacks but does not prevent the headaches. Ibuprofen, a non-steroidal anti-inflammatory drug, may alleviate mild headaches but lacks efficacy for preventing cluster headache attacks. Codeine, an opioid analgesic, is not indicated for treatment in this context due to concerns with dependence and its ineffectiveness in managing severe headache types. Therefore, verapamil stands out as the first-line prophylactic treatment choice.