Beta-Blockers For Migraines

  • Hania BegMSc Clinical Drug Development, Queen Mary University, London, UK
  • Priyanka ThakurBachelors in Medicine, Bachelors in Surgery (MBBS), DRPGMC, India

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Beta-blockers for Migraines- An Introduction

Sometimes, headaches can be severe and have accompanying symptoms which can cause them to be classified as migraines. A migraine is a neurological disorder and it can differ from an ordinary headache in several ways which will be explained in this article. 

Migraines are fairly common and they can be quite debilitating and interfere significantly with your normal life. Fortunately, there are several medications that are being used to not only treat migraines but also to prevent them. It is important to find the best treatment suited for you and once treated the occurrence of migraines can be controlled.

Understanding Migraines

It is important to separate a normal headache from a migraine so that it can be properly treated.  There are certain factors that can be used to differentiate the two. According to the International Headache Society, you must have had up to five headaches in your life which last from a minimum of 4 hours to up to 72 hours and are accompanied by two of the following:

  • Pain which is moderate to severe
  • A pulsing type of pain
  • Pain which is one side of the head
  • Impacts your daily activities 

And at least one of these characteristics: 

  • Sensitivity to light and sound
  • Nausea/vomiting 

Some people might also find that their balance or speech is also affected during a migraine attack. There may also be visual or other sensory problems before or during a migraine and these disturbances are known as aura. Some people experience aura with their migraine and some people do not. In addition, there can be a phase after a migraine attack which is known as the postdrome period and you may experience fatigue, muscle weakness or appetite changes. 

Some common migraine triggers are: 

  • Stress
  • Bright light or excessive noise 
  • Certain food/drinks such as caffeine, alcohol, cheese, meat etc.
  • Hormones may play a role such as during ovulation, pregnancy or around the menstrual cycle. 
  • Lack of sleep
  • Physical activity 
  • Changes in the weather1

Traditional Migraine Treatments 

There are two types of medication used for migraines; one is to prevent migraines (preventative) and one is to relieve the pain during a migraine attack (abortive). Your medication will be chosen according to how severe your attacks are, how many times you experience a migraine attack and what accompanying symptoms you have. You might have to try several medications before you find one that best suits you. 

Simple pain-relieving medication can be used during an attack such as ibuprofen or acetaminophen but these only really help pain that is mild. Another option is narcotic opioids and they can be used to stop mild/moderate pain. 

Triptans (sumatriptan, zolmitriptan etc) are another type of medication that are widely used as an abortive drug during migraines. They work best when they are taken at the first sign of a migraine attack and they are available as pills, injections or nasal sprays. However, triptans should not be used for more than 10 days in a month and those who carry a risk for strokes or heart attacks should avoid them altogether. Some people may also find the side effects of triptans too extreme or intolerable.2

Introduction to Beta Blockers 

Beta-blockers are a category of drugs that have been used to help prevent migraines, although this was not their original use. They were originally created for high blood pressure and certain heart conditions and they were discovered to also have a preventative effect on migraines.  These drugs work by blocking the binding of adrenaline to beta receptors in the body. Adrenaline is a stress hormone and when it cannot bind to receptors, its effect isn't brought about in the body and this causes your blood pressure to lower and your heart rate to decrease. 

The exact mechanism by which they prevent migraines is not yet fully understood but it is thought to be due to a restriction in blood flow to the brain, stabilising serotonin levels and or a decrease in stress levels. 

There are many different types of beta blockers but the most commonly prescribed one is propranolol.3 Other ones which might also be prescribed are timolol and atenolol. The usual starting dosage of propranolol is 40mg every day and you can slowly increase your dosage up to 320 mg, as needed.  

Beta-blockers can have some unwanted side effects such as:

  • Feeling dizzy or light-headed
  • Weight gain
  • Fatigue 
  • Cold hands and/or feet 
  • Nausea 
  • Having trouble sleeping 

These side effects occur due to decreased blood flow and heart rate in the body and they can be minimised by starting at a low dose and slowly working up a tolerance to higher doses.  If these side effects increase or do not go away over time, you can ask your doctor to prescribe a different beta blocker. Different people respond to different beta blockers and it is important to choose the best one for you.

Evidence of Beta blockers Efficacy 

There is proven evidence that beta blockers are effective in the prevention of migraines. There have been numerous and extensive clinical trials and research which have proven that beta blockers have a significant prophylactic effect on migraines.4

There are other preventative migraine treatments which are used such as anticonvulsants (topiramate), antidepressants (nortriptyline, amitriptyline), gabapentin or botox injections. However, anticonvulsants and antidepressants  have been shown to have many side effects which can be quite distressing and botox injections might not be an ideal option for people who suffer from needle phobia.3

Contraindications and Precautions 

Although beta blockers are useful for a number of conditions, they must be used with caution in some people.5 Since they cause the heart rate and the blood pressure to decrease, they cannot be used when a person has certain previous medical conditions such as: 

  • Lung diseases such as asthma or COPD
  • Previously low blood pressure or a slow heart rate
  • Diabetes
  • Congestive heart failure 
  • Previous heart or blood circulatory conditions 
  • Liver disease

These are not an exhaustive list of contraindications for the usage of beta blockers and your doctor will evaluate you properly before deciding if it is right for you. Beta blockers should also be avoided during pregnancy as they have not been deemed safe enough for use during this time. 

There are also some medications which cannot be taken alongside beta blockers and these include: 

  • Medicines used to lower blood pressure (antihypertensive)
  • Medicines used to regularise heart rate (antiarrhythmics) 
  • Medicines used for mental health issues (antipsychotics) 
  • Other medicines such as those used to treat malaria (mefloquine) or those used to treat migraines and hypertension together (clonidine)

Combining Beta Blockers with Other Migraine Therapies

At times, migraines might not be effectively treated with one medicine alone and your doctor might prescribe you two migraine medications at the same time. Various combinations have been explored and there is evidence that another medication alongside a beta blocker might be more effective than a single medication on its own. 

In one research,6 it was observed that the combined use of a beta blocker along with an anticonvulsant, sodium valproate, showed a significant reduction in the number of migraines. Furthermore, in another research it was proven that the addition of a third agent (an antidepressant) along with a beta blocker and an anticonvulsant (sodium valproate or topiramate) showed an even better response to migraines.7 

Although it is important that your doctor finds the right combination of medication to suit you, it is equally important that you comply strictly with these medications. Your doctor will explain how to take any medication they prescribe, as well as the correct dosage. In order to achieve optimal effects, you must remember to take these medications regularly, at the prescribed dosage. You should wait at least 3 months in order to allow the medication to reach its full potential, before deciding whether or not it is helping you. 

Along with medication, you should also try to avoid your known triggers as well as any common triggers which are listed in the beginning of this article. You should also try to manage your stress levels and try to engage in relaxation techniques. 

Summary

Suffering from migraines can be quite traumatic for an individual and they can severely impact your quality of life. Migraines can range from mild to severe and they can occur with or without other aura and prodromal period. They can often exhibit symptoms that involve the whole body such as problems with vision, balance etc. there are certain criteria which are used to differentiate a normal headache from a migraine. 

Beta-blockers are a class of medications that have been used to treat migraines for a long time. They have been proven effective and thus, are widely used to prevent migraines. However, there are some limitations with beta-blockers such as certain medical conditions and other medications which are a contraindication to their use. There are a number of other preventative medications which have also proven to be useful and often, these might be combined with beta-blockers to achieve an even better effect in the reduction of migraines. There are also some medications that are abortive and can be used to end a migraine attack, instead of preventing it. 

Finding the right balance of medication to treat your migraines is important but it might take a few months. Along with patience, you must remember to comply strictly with your medication schedule and dosage and try to apply certain lifestyle changes as well, to achieve optimal effects in the reduction of migraine attacks. 

References

  1. Kesserwani H. Migraine triggers: an overview of the pharmacology, biochemistry, atmospherics, and their effects on neural networks. Cureus [Internet]. [cited 2024 Jan 16];13(4):e14243. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088284/
  2. Nicolas S, Nicolas D. Triptans. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2024 Jan 16]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK554507/
  3. Kumar A, Kadian R. Migraine prophylaxis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2024 Jan 17]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK507873/
  4. Jackson JL, Kuriyama A, Kuwatsuka Y, Nickoloff S, Storch D, Jackson W, et al. Beta-blockers for the prevention of headache in adults, a systematic review and meta-analysis. PLoS One [Internet]. 2019 Mar 20 [cited 2024 Jan 17];14(3):e0212785. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426199/
  5. Koraćević G, Stojanović M, Kostić T, Lović D, Zdravković M, Koraćević M, et al. Contraindications differ widely among beta blockers and ought to be cited for an individual drug, not for the entire class. Curr Pharm Des. 2021;27(40):4125–32. https://pubmed.ncbi.nlm.nih.gov/34279195/
  6. Pascual J, Leira R, Láinez JM. Combined therapy for migraine prevention? Clinical experience with a beta-blocker plus sodium valproate in 52 resistant migraine patients. Cephalalgia. 2003 Dec;23(10):961–2. https://pubmed.ncbi.nlm.nih.gov/14984228/
  7. Krymchantowski AV. Combining therapies for the treatment of migraine: is there a role? Expert Review of Neurotherapeutics [Internet]. 2005 Mar [cited 2024 Jan 18];5(2):145–7. Available from: http://www.tandfonline.com/doi/full/10.1586/14737175.5.2.145

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Hania Beg

MSc Clinical Drug Development, Queen Mary University, London, UK

Hania is a medical doctor (MBBS), with a MSc in Clinical Drug Development. She has got extensive medical knowledge with prior experience in the Heathcare sector and an in dept understanding of drug development and pharmaceuticals. She is ICH-GCP certified with a special interest in medical writing and research.

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