Propranolol for Migraine Prevention

This blood pressure medication may help keep debilitating headaches at bay

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Propranolol is a beta blocker frequently prescribed to prevent certain types of migraine headaches. Sold under the brand names Inderal and InnoPran, and also as a generic product, this drug often falls under a broad category of drugs referred to as oral migraine prevention medications (OMPMs).

OMPMs are drugs that originally were created to treat other conditions but later found to help prevent migraine headaches. Like most such medications, propranolol has potentially intolerable side effects. That said, the American Academy of Neurology rates propranolol as a "level A" drug for migraine prevention, which means it's been found to be highly effective.

For that reason, if you and your healthcare provider are developing a plan to try to prevent migraine attacks, propranolol may be an option to consider. This overview of how the medication works, how it's taken, its potential side effects, and more will help you to make an informed decision.

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How Propranolol Works

As a beta blocker, propranolol is primarily used for cardiac conditions such as high blood pressure, heart rate irregularity, and stable/unstable angina. It's also prescribed to treat a certain type of adrenal gland tumor (a small gland above the kidneys). The way the drug helps to prevent migraine headaches is still not well-known. It is believed that propranolol helps stabilize the blood vessels in the brain, preventing their dilation.

In addition, the drug may reduce the excitability of the brain as well as improve patients' anxiety, helping decrease the frequency of the migraines. Beta blockers also stabilize serotonin levels (fluctuating serotonin levels are associated with migraines).

Once released into the bloodstream, adrenaline binds to blood vessels surrounding the brain, causing them to constrict. Propranolol and other beta blockers reverse this effect, causing vessels to relax and allowing the free flow of blood to the brain.


It's available as an immediate-release tablet or an extended-release capsule. The immediate release tablet should be taken on an empty stomach while the extended release capsule can be taken with or without food (but should be done consistently).

Studies investigating the use of propranolol have researched different doses. For example, in one study participants took 80 milligrams (mg) per day. But other reports suggest doses starting at 40 mg up to 160 mg daily.

For migraine prevention, a healthcare provider will usually prescribe 20 mg of propranolol three to four times a day to start. The dose then can be gradually increased if necessary to a therapeutic dose of 160 mg to 240 mg per day. Within four to six weeks, a person should experience a decrease in the number of their migraines by at least half, as well as a reduction in the intensity and duration of their migraine attacks.

The bottom line is that determining whether or not propranolol fails as a migraine preventive drug takes time, at least three months. This is certainly a downside, as those who suffer from migraines often (and understandably) become frustrated with this long waiting period. 

Side Effects

As with any medication, before starting propranolol, it is important to discuss any potential side effects with your healthcare provider. Below are some of the more common side effects seen with propranolol, although for the most part, it is a well-tolerated drug:

  • Fatigue
  • Dizziness
  • Constipation
  • Sleep problems
  • Stomach cramps


Since some substances may interfere with propranolol, it's important to tell your healthcare provider about all the medications (both prescription and over-the-counter), supplements, herbals, and vitamins you are taking.

For instance, propranolol significantly increases the levels (up to 70%) of the common migraine medications, Zomig (zolmitriptan) and Maxalt (rizatriptan). With that, if you are taking propranolol for migraine prevention and Maxalt for intermittent migraine attacks, you should lower your dose of Maxalt, under the guidance of your healthcare provider.


No controlled studies have assessed the use and safety of propranolol during pregnancy, therefore, it should only be taken if the potential benefit outweighs the potential risk to the baby. Moreover, propranolol is released into breastmilk, so be sure to tell your healthcare provider if you are breastfeeding.

It is unsafe for people with certain health conditions to take propranolol. Some of these conditions include:

  • Cardiogenic shock (severe heart failure)
  • Second or third-degree heart block
  • An allergy to propranolol


If you are taking propranolol, it is essential to take it only as prescribed by your healthcare provider. Stopping propranolol suddenly may cause worsening chest pain (called angina) and in some instances, heart attacks. In order to avoid these serious occurrences, it's important to slowly reduce your dosage of propranolol over at least a few weeks under the guidance of your healthcare provider.

Moreover, propranolol may also mask the signs of an overactive thyroid gland (called thyrotoxicosis), as well as low blood sugar, especially in people with insulin-dependent diabetes.

Besides people with diabetes and thyroid disease, propranolol may not be able to be used (or may need to be more closely monitored) in people with a baseline low heart rate or blood pressure, asthma, depression, or peripheral vascular disease.

It's best to avoid drinking alcohol while on propranolol. Alcohol can also lower your blood pressure. As a result, taking both propranolol and alcohol together can make your blood pressure dangerously low.

Although it's considered to be a well-tolerated and generally safe drug, there are other serious warnings associated with taking propranolol. Be sure to review these in detail with your healthcare provider to ensure it's the right drug for you.

A Word From Verywell

Propranolol is a reasonable starting point for most people's migraine prevention journey. Keep in mind, though, that propranolol only works for some people—it's not a magic cure and it requires a trial and error process, which can be tedious.

Fortunately there are other migraine preventive drug options, including other beta-blockers, non beta-blocking therapies such as the anti-seizure medication Topamax (topiramate), Botox (botulinum toxin type A), and an injectable drug called Aimovig (erenumab)

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6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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