Using Propranolol for Migraine Prevention

Medication May Relax Your Brain's Blood Vessels

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Propranolol for Preventing Migraines

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According to the American Academy of Neurology, propranolol (a high blood pressure medication) is considered a "level A" drug, which means it is effective and should be offered by headache specialists to their patients for migraine prevention.

While the "how" behind propranolol's role in migraine prevention is largely unclear, experts speculate that as a beta-blocker, propranolol blocks adrenaline (your flight or fight hormone) from binding to blood vessels surrounding the brain.

In essence, this relaxes the blood vessels, theoretically thwarting a migraine attack.

Keep in mind, though, research suggests that propranolol only works for some people—it's not a magic cure and thus, requires a trial and error process, which can be tedious, but worthwhile for some.

Formulation

Propranolol, known by the brand names Inderal and InnoPran in the United States, is approved by the Food and Drug Administration for preventing migraines and treating high blood pressure and essential tremor, among other conditions.

Propranolol is 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).

Dosing

For migraine prevention, a doctor will usually prescribe 20 milligrams (mg) of propranolol three to four times a day to start.

The dose is then gradually increased to a therapeutic dose of 160 to 240 milligrams 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. 

Adverse Effects

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

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

Interactions

Since some substances may interfere with propranolol, it's important to tell your doctor 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 percent) 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 doctor.

Contraindications

Propranolol is a pregnancy category C drug so 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 doctor 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

Warnings

If you are taking propranolol, it is essential to take it only as prescribed by your doctor. 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 doctor.

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.

Although, considered 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 doctor to ensure it's the right drug for you.

A Word From Verywell

In the end, propranolol is a reasonable starting point for most people's migraine prevention journey. But keep in mind that there are numerous other migraine preventive drug options, including other beta-blockers as well as non beta-blocking therapies like the anti-seizure medication Topamax (topiramate) or Botox (botulinum toxin type A) for chronic migraine prevention.

Even more exciting is the new once-a-month injectable drug that blocks calcitonin gene-related peptide (CGRP), called Aimovig (erenumab). This drug has been FDA approved to prevent both episodic and chronic migraine, and research suggests it is well-tolerated, although pricey.

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