Do Betablockers Work For Migraine Prevention? 2023
Betablockers are “Vasonormalizers” which prevent dilation and constriction of arteries. Adrenaline, the stress hormone, generated with fear, comes in two varieties: Alpha—which works on the lungs, and Beta—which works on arteries. Thus, the name Betablocker, a drug which prevents vasoconstriction and vasodilation of arteries.
The archetype Betablocker drug is Inderal, known generically as propranolol. It was the first drug approved by the Federal Drug Administration for the treatment of migraine in 1974 and is also used for other medical problems including.
Betablockers treat:
Migraine
Benign Essential and Familial Tremor
Hypertension
Angina (the chest pain heart patients get)
Cardiac Arrhythmias.
This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.
The American Academy of Neurology current update for pharmacologic treatment for episodic migraine prevention for adults is:
Strong evidence Metoprolol, propranolol, and timolol are established as effective and should be offered for migraine prevention (Level A).
Moderate evidence Atenolol and nadolol are probably effective and should be considered for migraine prevention (Level B).
Weak evidence Nebivolol and pindolol are possibly effective and may be considered for migraine prevention (Level C).
Acebutolol is possibly ineffective and may not be considered for migraine prevention (Level C negative).
Insufficient evidence. Evidence is conflicting or inadequate to support or refute the use of bisoprolol for migraine prevention (Level U)
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Related issues.
Available doses.
Propanalol 160-240mg/day as short acting Tab 10, 20, 40, 60, 80 mg taken as a divided dose bid (2X/day) or qid (4X/d). ER Cap 60, 80, 120, 160 mg taken as once a day.
Metoprolol 25-100 mg bid. Tab 25, 37.5, 50, 75, 100 mg.
Timolol 10-30 mg/day as qd-bid. Tab 5, 10, 20 mg.
Read more, “When to Start Preventive Therapy for Migraine?’ on my website, www.doctormigraine.com.
Side effects.
Propranolol: fatigue, dizziness, constipation, bradycardia, hypotension, depression, insomnia, weakness, disorientation, nausea, diarrhea, alopecia, impotence.
Metoprolol: fatigue, dizziness, diarrhea, pruritus, rash, depression, dyspnea, bradycardia, sleep disturbance, nightmares.
Timolol: bradycardia, heart block, fatigue, dizziness, headache, dyspnea, pruritis, Raynaud phenomenon, nightmares, impotence.
FDA Indications.
These drugs are indicated for :
Migraine, hypertension, angina, cardiac irregularities, essential and familial tremor.
Clinical experience comment.
Propranolol is the main drug of this group used for migraine prevention and it is usually well tolerated and has few side effects.
The only potential side effect I warn patients about is that a small number of patients develop the so called “Propranolol tired syndrome” after they start the drug, usually in the first week. If this side effect develops, then the drug should be stopped and another betablocker selected.
Betablockers may cause problems for patients with depression, diabetes, or asthma.
Duration of treatment.
For migraine I commonly encourage the patient to consider using the drug for 3-6 months at first. They should chart their headache numbers per month, and then reassess this on follow up. Many patients are able to get off the drug then although some patients with severe, frequent migraine headache will continue.
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Britt Talley Daniel MD