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How Do Beta Blockers Work For Migraines

Frequently Asked Questions About Propranolol

How do beta blockers work?

Does propranolol make you gain weight?

Propranolol can cause weight gain for some people, but it’s usually a small amount and temporary. If you notice you have gained more than 2 to 3 pounds in a day or more than 5 pounds in a week, please speak with your healthcare provider. This could be a sign of a more serious condition like heart failure.

Does propranolol work instantly?

Propranolol takes a few hours for the medication to be fully absorbed by the body, but you will most likely not see any benefits right away. It can take a few weeks of using propranolol for it to fully kick in and give consistent results. Just be careful not to stop the medication suddenly unless your healthcare provider tells you to do so.

Can I drink alcohol on propranolol ?

Drinking alcohol while taking propranolol is not a good idea. Alcohol can cause you to have more side effects from propranolol like low blood pressure and a very slow heart rate.

What is the best time to take propranolol ?

When it comes to taking your medications, we normally recommend taking them at the same time each day for consistency. This is also true for propranolol . If you are taking the long-acting capsule version of this medication, some people find they experience side effects like dizziness in the first few hours after taking propranolol . You might find it helpful to take the long-acting capsules at bedtime so you are asleep during the time you would feel these side effects.

What is Hemangeol used for?

Beta Blockers And Airways Disease

Beta-blockers can trigger bronchospasm and should therefore usually be avoided in patients with an established history of asthma. In the absence of a suitable alternative, it may be necessary for a patient with well-controlled asthma, or COPD , to receive treatment with a beta-blocker for a co-existing condition .

  • In this situation, a cardioselective beta-blocker should be selected and initiated at a low dose by a specialist the patient should be closely monitored for adverse effects.
  • Atenolol, bisoprolol, and metoprolol have less effect on the beta2 receptors and are, therefore, relatively cardioselective, but they are not cardiospecific. They have a lesser effect on airways resistance but are not free of this adverse effect.

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Dealing With Nausea And Vomiting

Migraine attacks may cause a feeling of sickness or cause you to actually be sick . The nausea makes it harder for your body to absorb migraine tablets into your body. If you take painkillers, they may remain in your stomach and not work well if you feel sick. You may even vomit the tablets back. Tips that may help include:

  • Use soluble painkillers. These are absorbed more quickly from your stomach and are likely to work better.
  • As mentioned, one brand of diclofenac comes as a suppository. This may be useful if you usually vomit with a migraine.
  • You can take an anti-sickness medicine in addition to painkillers. A doctor may prescribe one – for example, domperidone, prochlorperazine or metoclopramide.
  • Like painkillers, anti-sickness medicines work best if you take them as soon as possible after symptoms begin.
  • An anti-sickness medicine, domperidone, is available as a suppository if you feel very sick or vomit during migraine attacks.
  • Prochlorperazine comes in a buccal form which dissolves between the gum and cheek. This can be useful if you feel sick and do not wish to swallow a tablet.

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Who Shouldn’t Take Beta Blockers

While beta blockers are generally considered safe and effective, there are people who should consider other migraine treatments.


  • people who are taking other blood pressure medication
  • people who are taking certain antidepressants
  • people who are taking medicine to treat diabetes, asthma, chronic bronchitis, emphysema, or COPD
  • people who pregnant, planning to become pregnant, or breast-feeding
  • people with a history of a heart condition
  • people with asthma

That said, everyone’s different and you should speak to your doctor about your specific needs or concerns.

Who Should Take A Medicine To Prevent Migraine Attacks

How Beta Blockers Work Illustration by Fran Milner ...

There is no definite rule. For example, you may wish to consider this option if you have:

  • More than two migraine attacks per month that cause significant disruption to your life.
  • Less frequent, but severe, migraine attacks.
  • The need to use a lot of painkillers or triptan medicines to treat migraine attacks.
  • Painkillers or triptans for migraine attacks not working very well, or you are unable to take them because of side-effects or other problems.

Before embarking on preventative treatment, it is probably best to keep a migraine diary for a few months to assess:

  • How often and how bad your migraine attacks are.
  • Your current use of medication to treat the migraine attacks.

This may help you to decide if preventative treatment is worth a try, and also to help assess if you may have medication-induced headache. See the leaflet called Migraine trigger diary, including a migraine diary that you may like to print out and use.

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What Are The Treatment Options To Prevent Menstrual Migraine

Medications used to treat menstrual migraine are the same as those used to treat other forms of migraine. However, your doctor may recommend other treatments to be take regularly, in order to prevent or reduce the severity and frequency of menstrual migraines.

To find out more, see the separate leaflet called Migraine Triggered by Periods.

What Are The Side Effects Of Propranolol

With any medication, there are risks and benefits. Even if the medication is working, you may experience some unwanted side effects.

Contact your doctor immediately if you experience any of the following:

  • Heart failure

unusual drowsiness, dullness, or feeling of sluggishness

vivid dreams

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

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Do Not Suddenly Stop Taking Your Beta

Do not suddenly stop taking your beta-blocker without talking to your doctor first. This can be dangerous and make you feel unwell. You may get the feeling of changes in your heartbeat , an increase in blood pressure and a return of chest pains. If you do need to stop taking a beta-blocker then your doctor may advise a slow reduction in dose.

Pharmacist Tips For Propranolol

beta blockers in migraine and hypertension

The dose of propranolol depends on what you are taking it for. Take it exactly as prescribed by your healthcare provider.

Propranolol can be taken with or without food. Try to take it at the same time every day for best results.

Avoid any task that requires you to be alert until you know how you will respond to propranolol . Side effects like dizziness and fainting are more common when you first start this medication or right after your dose is changed. Most people find these side effects get better or go away within 1 to 2 weeks after starting propranolol .

Propranolol can cause dizziness, falling, or fainting, especially when going from a lying or seated position to a standing position. If this happens frequently, speak with your healthcare provider about other options to treat high blood pressure.

Propranolol can make it harder to know if you have low blood sugar. Be sure to check your blood sugar regularly if you have diabetes.

Don’t stop taking propranolol suddenly without talking to your healthcare provider. This can cause your blood pressure to rise to very high levels and raise your risk or having a heart attack or stroke.

If you miss a dose of propranolol , it is a good idea to just wait until your next scheduled dose instead of trying to take the missed dose. Don’t take 2 doses at the same time or extra doses. This could cause very low blood pressure, a low heartbeat, or extra side effects .

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What Are The Next Steps

As with any new potential treatment, the next step is rigorous clinical studies. However, much of the initial work has probably been accomplished, and can be extrapolated from completed studies of beta blocker in glaucoma patients and in migraine patients using beta blockers for migraine prevention. However, the initial step is to undertake a pilot study to establish a proof of concept that timolol eye drops are indeed effective as acute treatment of migraine. If that conclusion can be established, large clinical trials must be undertaken to further establish efficacy and safety of their use in acute migraine. Efforts are currently underway to conduct a pilot proof of concept study. If the proof of concept is established, then involvement of the FDA will be needed before the beta blocker eye drops could be approved treatment of acute migraine.

Treatment Options For Ocular Migraines

Ocular migraine is not well understood, and some treatments are supportive in nature, meant only to help deal with symptoms.

Certain medications can also be helpful in preventing an episode. Triptans, which are sometimes used to treat other types of migraines, are not typically used to treat ocular migraines. Some of the medications that may be used to treat ocular migraine include:

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What They Are Used For

Preventive medicines for migraine are taken to prevent migraine attacks. They are taken every day and are aimed at preventing migraine attacks altogether or at least reducing their frequency and severity.

If you are having at least four migraine attacks per month you may wish to discuss preventive medication with your doctor. There are a range of different preventive migraine medicines that can be taken, including several that are just becoming available in the UK.

What Are The Possible Side Effects Of Beta

How Beta Blockers Work Medical Illustration Medivisuals ...

Common side effects of beta-blockers include:4,7,9,10

  • Dizziness or lightheadedness
  • Gastrointestinal problems
  • Headache
  • Low blood pressure and slow heart rate

Other possible side effects include:

  • Cold hands and feet
  • Difficulty falling asleep or staying asleep

Beta-blockers should not be used by people with asthma, slow heart rate, or COPD.4

These are not all the possible side effects of beta-blockers. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with beta-blockers.

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How Well Do Beta

There are many different beta-blockers. Some prevent migraine better than others. The American Headache Society ranks their efficacy based on study results and the quality of the study.1 In general, drugs with the highest quality evidence should be tried first.4

The majority of studies are done in people with episodic migraine. The three beta-blockers with the most evidence for preventing migraine are:1

  • Propranolol
  • Metoprolol
  • Timolol

Propranolol is the best studied beta-blocker for migraine,4 and it is FDA-approved for migraine prevention.5 Timolol is also FDA-approved for migraine prevention.6 Migraine prevention is an off-label but commonuse of metoprolol.7

In people with episodic migraine, propranolol and metoprolol prevent about 1 headache per month.8 Studies of propranolol suggest it may not help people with chronic migraine.8 Timolol reduces the frequency of migraine by half in about 50% of people.6

There are fewer studies of atenolol and nadolol.8 The studies that have been done suggest that they are probably effective for migraine prevention.1 Nebivolol and pindolol are possibly effective for migraine, but they have not been well studied for this use.1,4

Types Of Preventive Migraine Medicine

The preventive medicine that are recommended to treat migraine fall into seven categories. Most preventive medications currently available are repurposed from other conditions. Here is an overview of each category, and tables of the different types of drugs in these categories and how they are taken can be downloaded here .

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Who Can And Cannot Take Propranolol

Propranolol can be taken by adults and children. But it is not officially approved for treating high blood pressure in children under 12 years old.

It is not suitable for everyone. To make sure it is safe for you, tell your doctor before starting propranolol if you have:

  • ever had an allergic reaction to propranolol or any other medicine

Tell your doctor if you’re trying to get pregnant, are already pregnant or if you’re breastfeeding.

Symptoms And Features Of Vestibular Migraine

Beta blockers and exercise

Vestibular Migraine can manifest through alarming symptoms like lightheadedness, ataxia, and sensations of moving while sitting still. Because symptoms are not the same for every person, it is incredibly easy to misdiagnose VM.

There are few clinical studies available on VM. Specialists in this field find themselves learning more every day about how to distinguish this diagnosis from other vestibular disorders like Meniere’s disease and benign paroxysmal positional vertigo .

Healthcare providers diagnose VM based on universal criteria set forth by the Barany Society and the International Headache Society. General practitioners receive little education in headache types, including Vestibular Migraine, so many people with symptoms of VM end up seeing several different doctors before they are accurately diagnosed.

Some of the common symptoms of Vestibular Migraine are:

  • Dizziness
  • Memory loss and brain fog
  • Ataxia
  • Positional and/or spontaneous vertigo episodes
  • Sensitivity to light and motion
  • Tinnitus
  • Nausea and vomiting
  • .

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Medicines Plus Behavioural Therapy

An interesting research study published in 2010 compared two groups of people who had frequent migraines. One group took a beta-blocker medicine alone. Another group took a beta-blocker but also had a course of behavioural migraine management . BMM included education about migraine, helping to identify and manage migraine triggers, relaxation techniques and stress management. After a number of months the group of people who took the beta-blocker plus BMM had, on average, significantly fewer migraines compared with the group who took beta-blockers alone. Further research is needed to confirm this and to look at BMM combined with other medicines to prevent migraine.

Caffeine And Vestibular Migraine

Interestingly, this same study also tested the effect of caffeine intake on Vestibular Migraine and unexplained dizziness. It found a 14% reduction in vestibular symptoms for those who completely quit caffeine, but 46% of patients found a reduction in dizziness with nortriptyline therapy.

This shows that eliminating caffeine can be a helpful addition, but medication provides the greatest reduction in symptoms of headache and dizziness.

Falling in between caffeine cessation and nortriptyline in terms of efficacy was treatment with topiramate , which resulted in a 25% reduction of dizziness.

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How Does Propranolol Work For Migraine

Propranolol works by blocking certain receptors, known as beta receptors, in blood vessels. This causes the vessels to relax and improve blood flow. It also slows down the heart rate. Researchers do not fully understand how Inderal works to prevent migraine.3 But since migraine are thought to result from changes to blood flow in the brain, it is possible that opening the vessels can serve as a mode of prevention.

Typical Dosing For Propranolol

Beta blockers for migraine prevention and anxiety? â Pink ...

The typical dose of propranolol tablets depends on the person and the health condition being treated and can range from 30 mg to 640 mg total per day. Your healthcare provider may start you on a lower dose and increase the amount over time.

  • High blood pressure: The typical dose is 120 mg to 240 mg by mouth twice a day.
  • Atrial fibrillation : The typical dose is 10 mg to 30 mg by mouth either 3 or 4 times a day before meals and at bedtime.
  • Heart protection after a heart attack: The typical dose is 60 mg to 80 mg by mouth 3 times a day.
  • Migraine prevention: The typical dose is 160 mg to 240 mg by mouth per day in divided doses.
  • Chronic chest pain: The typical dose is 80 mg to 320 mg by mouth either 2, 3, or 4 times a day.
  • Tremors: The typical dose to is 120 mg by mouth daily.
  • Thickening and narrowing of heart valves: The typical dose is 20 mg to 40 mg by mouth either 3 or 4 times a day before meals and at bedtime.
  • Tumor of the adrenal gland : The typical dose is 60 mg by mouth daily in divided doses for 3 days prior to surgery. If surgery is not possible, the typical dose is 30 mg by mouth daily in divided doses.

There is also an extended-release capsule version of propranolol . This version of propranolol gets released slowly in your body over time, meaning you only have to take it once a day. It is used to treat different medical conditions than the tablet version. Again, the dose depends on what it is being used to treat and ranges from 80 mg to 640 mg per day.

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Possible Side Effects Of Beta

Common side effects include the following:

  • Dizziness

Finally, beta-blockers can interact negatively with other drugs, including:

  • Insulin
  • Antidepressants
  • Cholesterol-lowering drugs

You must tell your doctor if you are taking other medications aside from beta-blockers. Provide a complete list of the drugs youre already taking. Also, we recommended that you avoid drinking alcohol if youre taking beta-blockers. Both beta-blockers and alcohol can reduce your blood pressure. If these two are combined, your blood pressure is at a high risk of falling to a dangerously low level.

Daily Use Side Effects May Limit Use

Since its impossible to predict when a migraine will happen, these medications must be taken daily. But the more often you have to take a medicine, the less likely you are to take it faithfully. If you dont have the symptom right away when you skip a dose, then you are even more likely to skip doses, says Dr. Schramm.

All medications, and herbal remedies, have the potential to cause side effects, cautions Dr. Schwamm. Antiseizure medicines can reduce concentration and may cause drowsiness. Beta blockers can slow the heart rate and sometime cause depression or sexual dysfunction. Topiramate can cause weight loss, so some patients are more compliant with this drug, says Dr. Schramm.

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