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Dose of verapamil for cluster headache [see Pharmacotherapy (12.3)]. However, in clinical practice, the dose of verapamil recommended above tends to be unnecessary and is commonly considered to be ineffective because there is no clinical evidence demonstrating a benefit. In fact, patients who are treated with placebo in these settings are more likely to be treated inappropriately than those with verapamil. A recent study compared the efficacy of a low dose duloxetine vs. placebo for cluster headache but found that only 9.7% of the patients in each group were treated appropriately. Other agents, including mirtazapine and pregabalin [see Adverse Reactions (6.2), and Use in Specific Populations (8.7)], are available and may be an acceptable option if the efficacy and tolerability of duloxetine are unapparent. CASE REPORT A 29-year-old man developed 3-day episode of severe, disabling, migraine-like headache that persisted throughout the month until discontinuation of medication during a course treatment for other conditions. He was experiencing worsening migraine symptoms, such as vertigo, every 2 or 3 days. He was taking the medication at a dose level of 1 mg/day, with titration up to 2.5 mg/day. He had taken a single tablet daily for over 3 weeks, with improvement in frequency and severity of headaches since the first week. He began to take the 3.75–4 mg/day dosage, with a decrease of 4–5 milligrams per day to a daily starting dose of 3.75 mg. He noted significant improvement in his headache as of week 4. He took one tablet daily at 4 a.m. and 2.25–3.5 hours after waking, taking no later than 1 p.m. The pain was tolerable at 4 a.m. He reported decreased nausea and vomiting; headache did not appear at this time. 4 a.m. he Olanzapine 7.5mg $45.6 - $1.52 Per pill took a tablet to take back work. He experienced complete resolution of headache and no nausea or vomiting returned to work at shortly after. In this episode, the duration of illness varied from 3 days to several weeks. DISCUSSION Although no pharmacologic agent has imp