Beta-Blockers for Migraine Prevention

These hypertension drugs may help thwart migraine attacks

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Beta-blockers, which are normally used to treat hypertension (chronic high blood pressure), may also be prescribed to prevent migraines. There is a link between headaches and high blood pressure, but beta-blockers can prevent migraines even if you don't have hypertension.

You and your doctor can decide whether you need to take a prophylactic migraine medication based on the frequency of your migraines, how long they last, how many migraine days you have per week or month, and whether they improve with abortive treatment (that which is used at the time of an acute migraine attack).

How They Work

Beta-blockers are taken on an everyday basis to reduce blood pressure, and they are also used daily when recommended for migraine prevention.

Beta-blockers relax blood vessels throughout the body, which is why they are used for the management of hypertension. They exert this effect by acting directly on β-adrenergic receptors, which are located in the wall of blood vessels.

Beta-blockers have several actions that may help in reducing migraines. Among them:

  • Beta-blockers reduce cerebral (brain) blood flow by directly acting on the blood vessels in the brain. Vasodilation (widening of the blood vessels) is associated with migraines.
  • They induce a change in the electrical activity of the brain, preventing an effect described as cortical spreading depression—a type of slow brain activity associated with the early stages of migraine.
  • These medications may also increase activity in the hypothalamus, a region of the brain that has been associated with migraines.

It isn't completely clear which of these effects occurs first or which has the most powerful impact on reducing migraines, and it is likely that a combination of these actions is responsible for the effect on migraine reduction.

Options

There are a number of different beta-blockers, but they are not all are used for migraine prevention. In addition, if you are already taking a beta-blocker for hypertension, this does not automatically mean that it will prevent your migraines.

Inderal (propranolol) is the beta-blocker that has been used and studied the most when it comes to migraine prevention. According to the United States Headache Consortium, there is evidence that propranolol can reduce the frequency of migraines. It is taken at a dose of 120 to 240 mg per day for migraine prevention. Blocadren (timolol), Tenormin (atenolol), and Corgard (nadolol) may also be effective.

Secral (acebutolol), Trasicor (oxprenolol), and Visken (pindolol) are beta-blockers that work a little differently and are not considered effective in migraine prevention.

Your doctor will determine the right beta-blocker and dose for you based on factors such as your medical history and the other medications you are taking.

Side Effects

There are some side effects of taking a beta-blocker. Because they reduce blood pressure, they can cause hypotension (low blood pressure), which may result in lightheadedness, confusion, or loss of consciousness. This is not common, but you should be aware of the possibility of hypotension when taking an antihypertensive.

Other side effects of beta-blockers include:

  • Fatigue
  • Reduced exercise tolerance
  • Nausea
  • Dizziness
  • Insomnia
  • Depression

Interactions

You may experience adverse effects if you take beta-blockers along with other blood pressure medications, asthma medications, or barbiturates, such as Fioricet (butalbital/acetaminophen/caffeine) or Fiorinal (butalbital/aspirin/caffeine).

It is important to tell your doctor and pharmacist about all of the medications you take, including any over-the-counter medications, vitamins, or supplements. Even herbal supplements can have actions that interact with prescription medications such as beta-blockers.

Contraindications

If you have certain medical conditions, beta-blockers can exacerbate them. You might not be able to tolerate beta-blockers if you have heart block, asthma, low blood sugar, Raynaud's phenomenon, or vascular disease. Beta-blockers may also worsen depression.

If you have a low or borderline low blood pressure— lower than 90 mm Hg systolic pressure (the higher number) or lower than 60 mm Hg diastolic pressure (the lower number)— then beta-blockers can lower your blood pressure even further, which is dangerous.

A Word From Verywell

There are a number of strategies used for migraine prevention. Daily prescription medications such as beta-blockers are most effective when combined with other preventative approaches, such as stress management and avoiding triggers.

Be sure to discuss any side effects with your doctor and be observant of your migraine frequency after you start beta-blockers so that you can assess if (and how well) they are working.

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