Beta-Blockers

Beta-blockers are a type of medicine commonly used to treat high blood pressure. But beta-blockers can also be an effective migraine preventive treatment.^1,2

Beta-blockers are taken by mouth every day, with the goal of reducing the frequency, duration, or severity of migraine attacks. People who may benefit from this treatment include those who:^1-3

• Experience severely disabling migraine attacks
• Have frequent migraine attacks (4 or more per month)
• Cannot use acute treatments (used to treat symptoms of an attack once it starts)

Beta-blockers do not stop a migraine attack in progress. Instead, they work in between migraine attacks to help your body stay headache-free and hopefully improve your quality of life. Research shows that beta-blockers are especially helpful for people with episodic migraine.^1-4

How do beta-blockers work?

Beta-blocker medicines affect the blood vessels in the brain, make the nervous system less excitable, and increase activity in the part of the brain that keeps the body in a balanced state (hypothalamus).^1,2

Beta-blockers can be a good choice for people who have both migraine and certain heart diseases, such as:^1-4

• High blood pressure
• Chest pain (angina)
• Heart palpitations or panic attacks
• Diseases that narrow the arteries (ischemic heart diseases)

Examples

There are many kinds of beta-blockers available for migraine treatment. Some have more support in the medical literature in terms of efficacy in preventing migraine compared to others.^1-3

For this reason, these are the beta-blockers most commonly prescribed for migraine:^4-8

• Propranolol (Inderal^® LA, Inderal^® XL, InnoPran^® XL)
• Metoprolol (Lopressor^®, Toprol^® XL)
• Timolol

In a study of people with episodic migraine, propranolol and metoprolol were effective in reducing headache frequency by 1.5 headaches per month. Over time, people who took propranolol were also more likely to:⁹

• Report a 50 percent reduction in headaches
• Need less pain medicine

Though there are fewer studies of atenolol and nadolol, these drugs are also probably effective for migraine prevention. Talk to your healthcare provider about which drug or treatment plan may be right for you.^4,9

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. Beta-blockers can cause the following side effects:^1-3

• Low heart rate
• Low blood pressure
• Activity intolerance
• Fatigue
• Erectile dysfunction
• Vivid dreams
• Airway bronchospasm
• Depression

These are not all the possible side effects of beta-blockers. Talk to your healthcare provider about what to expect when taking beta-blockers. You also should call your healthcare provider if you have any health concerns that may come up when taking a beta-blocker.

Other things to know

Beta-blockers may worsen asthma attacks. For this reason, people who have poorly managed asthma should not use a beta-blocker.^1-3

Similarly, people with a slow heart rate, circulation issues, diabetes, or chronic obstructive pulmonary disease (COPD) should use caution when considering taking this treatment.^1-3

In people with diabetes, beta-blockers may hide the effects of low blood sugar, like a rapid heartbeat. If you have diabetes and are taking a beta-blocker, it is important to monitor your blood sugar regularly.^1-3

Beta-blockers can cause problems for people who take other medicines. Before beginning treatment for migraine, tell your healthcare provider about all your health conditions and any other medicines, vitamins, or supplements you take. This includes over-the-counter medicines.⁹