Beta Blockers and Migraines: Prevention and Treatment

Instructor: Rachel Torrens

Rachel is a Nurse Practitioner with experience working as a high school teacher, skin surgery center, and as a family NP.

Migraines are a common ailment, but the pain they cause is significant. In this lesson, learn about beta-blockers and their use in migraine prevention.

The Power of a Migraine

You can feel it starting. Your head throbs and a wave of nausea causes you to almost throw-up. Panicked you stumble to your bedroom, draw the curtains and collapse on your bed. Any light or sound that penetrates your safe haven causes the pain to double. This is the reality of having a migraine; it is intensely horrible.

Many people have suffered a headache at some point. But a migraine is a headache of a different caliber. Migraines are often debilitating, leaving the affected person helpless until the migraine passes.

Usually a person experiencing a migraine is unable to function normally.
Woman with a migraine

Luckily, there are modern medicines that help to treat a migraine once it begins, known broadly as acute migraine treatments. Many times these medications alleviate symptoms quickly. But for some, the time it takes for the medication to become active is too long or the number of migraine attacks is too frequent. For such people, healthcare providers turn to preventative migraine treatments, which are medications that can prevent migraines from even starting.

Preventing a Migraine

Now, not everyone who has experienced a migraine necessarily needs preventative therapies. Rather, there is a guideline for those whom it would most help, which includes:

  • Two or more migraines per month causing a person to be nonfunctioning for three or more days per month
  • Failure to respond or contraindications for acute migraine treatments
  • Using acute migraine treatments more than twice per week

It is important to understand that as a preventative medication, the drug must be taken on a daily basis regardless of symptoms. The purpose of this medication is not to treat the migraine when it happens, but to prevent it from occurring in the first place or to minimize symptoms if a migraine should occur.

Most often, healthcare providers recommend the 'Start low, and go slow' approach to preventative migraine therapy. This means that the lowest dose of preventative medication is given, and slowly titrated upwards until the patient reports a relief in frequency or symptoms. Sometimes it can take up to six months to find the correct dose of the proper preventative medication.

Beta-blockers to the Rescue

Migraines are a very complex ailment. In fact, despite being the third most common ailment in the world, much remains unexplained as to what causes a migraine attack. However, sometimes while treating one thing, healthcare providers notice a marked improvement in something completely different. This is the story of beta-blockers and migraines.

Traditionally beta-blockers have been used to treat heart-related concerns, such as high blood pressure, irregular heartbeats or chest pain. Well, in the 1960s, a physician was studying the benefits of a specific beta-blocker, called propranolol, in alleviating chest pain. One of his trial patients reported that while taking propranolol on a daily basis, the number and intensity of his migraines was significantly diminished. This was not the finding the physician was expecting, but he published it nevertheless! Several other research studies were conducted and yielded similar results. So a decade later, the federal Food and Drug Administration approved certain beta-blockers for use as migraine preventative therapies.

Examples of Beta-blockers

Two of the most common, tried and true beta-blockers used for migraine prevention are:

  1. propranolol
  2. timolol

Propranolol is considered a first-line migraine prevention therapy.
Propranolol pill

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