Propranolol is Not the Right Fit for My Migraines

This doctor’s appointment was not going well. I needed to talk to her about my current migraine medication regime. I’d had a change in my migraine symptoms. I used to get infrequent, completely debilitating migraines with aura. Now I get frequent, not always debilitating migraines with or without aura and with or without pain. I didn’t want to continue my current rate of taking sumatriptan because I was worried it wasn’t good for me long term.

At first, my doctor was validating. She said that, yes, I did need a new medication plan because taking too much headache medicine could cause rebound headaches. We certainly didn’t want that.

What was our conversation about propranolol?

“I see you had been taking propranolol,” my doctor said.

“Yes, your predecessor prescribed it for anxiety as needed,” I said. My old doctor had left the practice and had assigned me to this one, who I’d met once before.

“But you’re not taking it anymore?”

“It didn’t really work well enough for the anxiety anymore,” I said. I had been prescribed it right before the pandemic, and it had helped for a while, but then I had some good ole trauma and was later diagnosed with a panic disorder. My medication had changed then.

“You can take it daily to prevent migraines,” the doctor said, flexing her fingers, ready to add in the refill on my chart.

“Well, I had some side effects on it, so I don’t really want to take that again,” I said. When she raised her eyebrows I continued, “It made me too tired. And I had some exercise intolerance.”

How did she react to my side effects?

I live in a hilly neighborhood, and, despite walking up and down my street with my dog every single day when I was taking propranolol, getting up the hill every time made me so out of breath, I couldn’t talk, even when I had been doing it for months.

She looked at my chart. “No,” she said, “you can’t have had exercise intolerance on that low of a dose.”

I didn’t know what to say. I’d had exercise intolerance. I generally have low blood pressure, and taking propranolol made me less likely to panic if I happened to take it on time before a huge stressor, but it also made me feel sinkable and washed out. I’m generally sensitive to drugs and am often prescribed the lowest doses, especially for mental health medications.

My doctor said, “I think you should take propranolol every day to prevent migraines.”

The thought of depleting myself even more than I already was made me feel panicky. I’m already tired most days, a product of being a human, a single parent during a pandemic, and parenting two young, neurodiverse kids while dealing with my own mental health.

“Or you can take topiramate,” she said. She sighed, “but you do have to build up to it for it to work. It won’t work tomorrow.”

Did I want to take topiramate for migraine?

I can be patient. I’ve been nothing but patient these last few years, waiting for schools to open, waiting for vaccines. I can wait a few weeks to stop the migraines that have been happening frequently, sometimes daily.

She filled a prescription for topiramate. Here’s hoping.

Also, I’m getting a new primary care doctor. Even though they often know best in terms of medications and side effects, when your doctor tells you your experience is not valid, seek a second opinion.

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