Propranolol for Migraine Prevention

This blood pressure medication may help keep debilitating headaches at bay

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Propranolol is a drug often prescribed to prevent certain types of migraine headaches. It is sold under the brand names Inderal and InnoPran and as a generic product.

This drug falls under a broad category of drugs called oral migraine prevention medications (OMPMs). These are drugs that were developed to treat other conditions but were later found to be helpful for migraines. Like most such medications, though, propranolol may have intolerable side effects.

The American Academy of Neurology rates propranolol as a "level A" drug for migraine prevention. This means it's been found to be highly effective.

This article looks at propranolol for the prevention of migraine, how it works, and how it's taken. It also discusses potential side effects.

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How Propranolol Works

Propranolol is beta blocker. It is usually used to treat cardiac conditions, such as:

It's also prescribed to treat a certain type of tumor of the adrenal gland, a small gland above the kidneys.

The way propranolol helps prevent migraines is still not well-known. It may help stabilize the blood vessels in the brain, preventing their dilation. It may also reduce the excitability of the brain and improve anxiety, which may help decrease the frequency of migraines. Beta blockers also stabilize serotonin levels. Serotonin is a substance in the brain that helps with mood regulation. Fluctuating serotonin levels are associated with migraines.

When adrenaline is released into the bloodstream, it binds to blood vessels surrounding the brain. This makes them constrict. Propranolol and other beta blockers reverse this effect. The vessels relax and let blood flow freely to the brain.

Propranolol Dosage

Propranolol is available as an immediate-release tablet or an extended-release capsule. The immediate release tablet should be taken on an empty stomach. The extended release capsule can be taken with or without food. Take the extended release capsule the same way each day: always with food or always without.

Studies have looked at different doses of propranolol. In one, participants took 80 mg per day. Other reports suggest doses starting at 40 mg up to 160 mg daily.

For migraine prevention, doctors usually prescribe 20 mg of propranolol three to four times a day to start. If necessary, the dose is gradually increased to a therapeutic dose of 160 mg to 240 mg per day.

It takes between four and six weeks for propranolol to start working. If the drug works for you, the frequency of your migraines may reduce by half or more. There should also be a reduction in the intensity and duration of migraine attacks.

The length of time it takes to see results is a downside of this drug. Many people with migraines understandably become frustrated with the long wait time.

Potential Side Effects of Propranolol

Propranolol is usually very well tolerated, but side effects can happen. As with any medication, discuss potential side effects with your doctor before you start taking this drug. Some of the more common include:

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

Drug Interactions

Some substances may interfere with propranolol. For this reason, it's important to tell your doctor about all the medications you're taking, including:

  • Prescription medications
  • Over-the-counter medications
  • Supplements
  • Herbals
  • Vitamins

For example, propranolol significantly increases the levels of some common migraine medications by up to 70%. These drugs include Zomig (zolmitriptan) and Maxalt (rizatriptan). If you are taking propranolol for migraine prevention and Maxalt for migraine attacks, you should lower your dose of Maxalt under the guidance of your doctor.

Who Should Not Take Propranolol?

No controlled studies have looked into the use and safety of propranolol during pregnancy. You should only take this drug if the potential benefit outweighs the potential risk to the baby. Propranolol is also released into breastmilk, so be sure to tell your doctor if you are breastfeeding.

Propranolol is unsafe for people with certain health conditions. Some of these include:

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

Propranolol Warnings

Take propranolol only as prescribed by your doctor. Stopping it suddenly may cause worsening chest pain, called angina. In some cases, stopping suddenly could even lead to a heart attack. To avoid these serious effects, slowly reduce your dosage of propranolol over at least a few weeks under the guidance of your doctor.

Propranolol may also mask the signs of thyrotoxicosis or overactive thyroid gland. It can also mask the signs of low blood sugar, especially in people with insulin-dependent diabetes.

Certain other conditions may exclude you from being able to take propranolol, or require that you take it while closely monitored. These include:

Avoid alcohol while on propranolol. Alcohol can also lower your blood pressure. Taking propranolol and alcohol together can make your blood pressure dangerously low.

Propranolol is considered a well-tolerated and generally safe drug. Still, there are other serious warnings associated with taking it. Be sure to review these in detail with your doctor to ensure it's the right drug for you.

Summary

Propranolol is a beta blocker that is sometimes prescribed for the prevention of migraines. It may work by preventing the dilation of blood vessels and stabilizing serotonin levels.

If propranolol works for you, your migraine attacks will be shorter, less intense, and less frequent. It may take up to six weeks before you'll notice this effect.

Propranolol may cause side effects and may interact with other medicines. Make sure to discuss the benefits and drawbacks with your doctor before you start taking this drug.

A Word From Verywell

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

If propranolol is not right for you, there are other drug options for preventing migraine. These include 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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