Beta-Blockers: Quick Look
|Use||Prevent migraine or reduce the severity of attacks|
|Migraine-specific?||No, but metoprolol and timolol are FDA approved for migraine prevention|
|Side effects||Infrequent to occasional:2 Dizziness, tiredness, gastrointestinal symptoms|
|Drugs in this class|
|Brand Name(s)||Generic Name|
|Inderal LA, Inderal XL, InnoPran XL||propranolol|
|Lopressor, Toprol XL||metoprolol|
Beta-blockers are heart drugs that lower blood pressure. In the 1960s, doctors and patients noticed they also reduced migraine frequency.3 Today, they are the most commonly used drugs for preventing migraine.4 Beta-blockers will not stop a migraine that has started.
These drugs can be a good choice for people who have migraine plus certain common heart diseases.4 Examples include high blood pressure, angina (chest pain), or heart problems that narrow the arteries (ischemic heart disease).
These medications are taken by mouth once or twice per day. Your health care provider will probably start you on a low dose and increase it as needed. Follow your health care provider’s instructions about how to take this medication. If you are going to stop taking beta-blockers, you must taper off them. Do not discontinue beta-blockers suddenly. This may cause chest pain or heart attack.
How well do beta-blockers work for migraine?
There are many different beta-blockers. Some prevent migraine better than others. The American Headache Society ranks their efficacy based on study results and the quality of the study.1 In general, drugs with the highest quality evidence should be tried first.4
The majority of studies are done in people with episodic migraine. The three beta-blockers with the most evidence for preventing migraine are:1
- Propranolol (Inderal® LA, Inderal® XL, InnoPran® XL)
- Metoprolol (Lopressor®, Toprol® XL)
Propranolol is the best studied beta-blocker for migraine,4 and it is FDA-approved for migraine prevention.5 Timolol is also FDA-approved for migraine prevention.6 Migraine prevention is an “off-label” (unapproved)—but common—use of metoprolol.7
In people with episodic migraine, propranolol and metoprolol prevent about 1 headache per month.8 Studies of propranolol suggest it may not help people with chronic migraine.8 Timolol reduces the frequency of migraine by half in about 50% of people.6
There are fewer studies of atenolol and nadolol.8 The studies that have been done suggest that they are probably effective for migraine prevention.1 Nebivolol and pindolol are possibly effective for migraine, but they have not been well studied for this use.1,4
What are the possible side effects of beta-blockers?
Common side effects of beta-blockers include:4,7,9,10
- Dizziness or lightheadedness
- Gastrointestinal problems (nausea, diarrhea, constipation, or heartburn)
- Erectile dysfunction
- Low blood pressure and slow heart rate
Other possible side effects include:
- Cold hands and feet
- Difficulty falling asleep or staying asleep
Beta-blockers should not be used by people with asthma, slow heart rate, or COPD.4
How do beta-blockers prevent migraine?
It is not entirely clear why beta-blockers help to prevent migraine. At one time, people thought that problems with the blood vessels in the head caused migraine. Therefore, for years, migraine was treated using drugs that affected blood flow in the brain. Today, it has been established that there is more to migraine than overexcited blood vessels.
What other blood pressure medications are used to prevent migraine?
Other blood pressure medications have been used for migraine. These drugs might be considered if other options have not worked. Four drugs classified as possibly effective are:1
- Atacand (candesartan), an angiotensin receptor blocker
- Qbrelis, Prinivil, Zestril (lisinopril), an ACE inhibitor
- Catapres (clonidine), an alpha-agonist
- Guanfacine, an alpha-agonist
It is always important to talk to your doctor about all the medications you are taking, because some do not mix well with beta blockers. You should begin no medication or supplement without first checking with your health care provider and should let them know of any other prescriptions, OTCs, and herbals you are taking to ensure there are no interactions.