Reviewed by: HU Medical Review Board | Reviewed April 2022 | Last updated: February 2023
|Use||Prevent migraine or reduce the severity of attacks|
|Migraine-specific?||No, but timolol and propranolol are FDA approved for migraine prevention and metoprolol is an "off label" (unapproved) beta blocker used for migraine prevention.|
|Side effects||Infrequent to occasional:2 Dizziness, tiredness, gastrointestinal symptoms|
|Drugs in this class|
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).
Which 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)
Are they all FDA-approved to prevent attacks?
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
How well do they work?
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?
Common side effects of beta-blockers include:4,7,9,10
- Dizziness or lightheadedness
- Gastrointestinal problems (nausea, diarrhea, constipation, or heartburn)
- Decreased libido
- 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
These are not all the possible side effects of beta-blockers. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with beta-blockers.
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?
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 not begin a medication or supplement without checking with your health care provider first and should let them know of any other prescriptions, OTCs, and herbals you are taking to ensure there are no interactions.