Beta-Blockers
Beta-blockers are drugs that relax blood vessels and block the effects of adrenaline in the body. Traditionally used to treat heart disease, beta-blockers became recognized for their usefulness in the prevention of migraine in the 1970s. Those that are FDA approved for this use include propranolol hydrochloride (Inderal) and timolol maleate (Blocadren). Other beta-blockers that have been studied in migraine prevention and may be prescribed “off label” for the purpose, but are not FDA approved for this use include atenolol (Tenormin), nadolol (Corgard), and metoprolol (Lopressor, Toprol).
Propranolol is the oldest and most widely studied of the migraine prophylactic beta-blockers to date. It is also the least expensive of the first-line migraine preventative drugs (in its generic form).
Potential side effects of beta-blockers include fatigue, sleep problems, depression, decreased physical endurance, and impotence. Propranolol and other beta-blockers decrease blood pressure and could cause dizziness and fainting in people with normal to low blood pressure as a result.
The FDA has not yet approved any medication for the prevention of migraine in children and teenagers. However, the Cochrane Review, an evidence-based review of available research on health care interventions, found that the beta-blocker propranolol hydrochloride and the calcium channel blocker flunarizine (available in Canada only) may be effective prophylactics for this age group.
Migraineurs who have lung or breathing problems such as asthma and chronic obstructive pulmonary disease (COPD) should not take beta-blockers, as these drugs can cause breathing to deteriorate. They are also not recommended for use in people who have bradycardia (slow heart rate) or electrical conduction problems with their heart. Beta-blockers can interact with or impact the efficacy of a number of over-the-counter and prescription medications; make sure your doctor is aware of all the drugs you take to prevent dangerous interactions.
