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What Do Beta Blockers Do For Migraines

Vestibular Migraine Is A Common Cause Of Headaches And Dizziness But It Can Occur Without Pain Discover The Evidence Behind Vestibular Migraine Treatments

When I began to experience the strange sensations that come with Vestibular Migraine, I thought I was losing my mind. Some days I felt as though the car would be moving forward and I had to slam on my brakes, even though it was still in park.

Other days I would have daily background dizziness that made it hard to walk or think clearly. The worst days included a terrifying spinning sensation, and that’s when I knew I needed to pursue a diagnosis.

After seeing 7 different physicians who got it all wrong, I was finally diagnosed with Vestibular Migraine . I sat there in disbelief. How on earth could these symptoms be Migraine?

Papers Of Particular Interest Published Recently Have Been Highlighted As: Of Importance Of Major Importance

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    Rabkin R, Stables D, Levin N, et al. The prophylactic value of propranolol in angina pectoris. Am J Cardiol. 1966;18:370–83.

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    Quirke V. Putting theory into practice: James black, receptor theory and the development of the beta-blockers at ICI, 1958–1978. Med Hist. 2006;50:69–92.

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    • Sprenger T, Viana M, Tassorelli C. Current prophylactic medications for migraine and their potential mechanisms of action. Neurotherapeutics. 2018;15:313–23 A recent and comprehensive review of prophylactic migraine medications and their possible mechanism of action related to migraine pathophysiology.

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    Schoenen J, Ambrosini A, Sandor PS, et al. Evoked potentials and transcranial magnetic stimulation in migraine: published data and viewpoint on their pathophysiologic significance. Clin Neurophysiol. 2003;114:955–72.

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    Nyrke T, Kangasniemi P, Lang AH, Petersen E. Steady-state visual evoked potentials during migraine prophylaxis by propranolol and femoxetine. Acta Neurol Scand. 1984;69:9–14.

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    Gehrwig M, Niehaus L, Stude P, et al. Beta-blocker migraine prophylaxis affects the excitability of the visual cortex as revealed by transcranial magnetic stimulation. J Headache Pain. 2012;13:83–9.


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    Johnson KW, Phebus LA, Cohen ML. Serotonin in migraine: theories, animal models and emerging therapies. Prog Drug Res. 1998;51:219–44.

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  • What Are The Drugs That Interact With Ace Inhibitors And Beta Blockers

    ACE Inhibitors

    ACE inhibitors have few interactions with other drugs.

    Beta blockers

    • Combining propranolol or pindolol with thioridazine or chlorpromazine may result in low blood pressure and abnormal heart rhythms because the drugs interfere with each other’s elimination and result in increased levels of the drugs.
    • Dangerous elevations in blood pressure may occur when clonidine is combined with a beta blocker, or when clonidine or beta blocker is discontinued after their concurrent use. Blood pressure should be closely monitored after initiation or discontinuation of clonidine or a beta blocker when they have been used together.
    • Phenobarbital and similar agents may increase the breakdown and reduce blood levels of propanolol or metoprolol . This may reduce effectiveness of the beta blocker.
    • Aspirin and other nonsteroidal anti-inflammatory drugs may counteract the blood pressure reducing effects of beta blockers by reducing the effects of prostaglandins, which play a role in control of blood pressure.
    • Beta blockers may prolong hypoglycemia and mask symptoms of hypoglycemia in diabetics who are taking insulin or other diabetic medications.

    What Are Beta Blockers And How Do They Help Treat Migraine Headaches

    Beta blockers are prescription drugs commonly prescribed to control blood pressure and/or treat high blood pressure. They can also be taken to manage abnormal heart rhythms and protect the heart from a second heart attack.

    What’s likely more important for you is that that they’re proven to be an effective preventive migraine treatment. To understand why that is, we need to quickly talk about what researchers believe causes migraines: For unknown reasons, at the start of a migraine, your brain’s blood vessels constrict and make your brain think that it needs a lot more blood than it really does. The blood vessels respond by dilating, resulting in a rush of blood to the brain. Beta blockers alleviate that pain by telling your blood vessels to relax so that the blood can flow normally.

    The three most common beta blockers used for migraine prevention are:

    What Other Blood Pressure Medications Are Used To Prevent Migraine

    How Does Propranolol Work?

    Other blood pressure medications have been used for migraine. These drugs might be considered if other options have not worked. Four drugs classified as possibly effective are:1

    • Atacand , an angiotensin receptor blocker
    • Qbrelis, Prinivil, Zestril , an ACE inhibitor
    • Catapres , an alpha-agonist
    • Guanfacine, an alpha-agonist

    It is always important to talk to your doctor about all the medications you are taking, because some do not mix well with beta blockers. You should begin no medication or supplement without first checking with your health care provider and should let them know of any other prescriptions, OTCs, and herbals you are taking to ensure there are no interactions.

    Coming Off Propranolol Beta Blocker Medication To Treat Migraines

    At the age of 16 I was prescribed propranolol medication to help reduce the frequency of migraines attacks. My dosage increased from 10mg to 80mg at the hospital. I’ve talked about the side effects of beta blockers before but my decision to gradually stop taking them was a big one to make. The biggest bother was extreme sensitivity to cold and pins and needles through my whole body. I also made the decision to stop with the hope it would help the discolouration in my skin. . I’d like to talk about the feelings I’ve had since I’ve stopped taking the medication. 

    A Pain Score Reduction Of Four Points Occurred In 82% Of Timolol


    Oral ?-blockers have been used for migraine headache prevention, but they haven’t been shown to effectively treat acute pain. Some small case series, however, have suggested that topical ?-blockers might help when an acute migraine strikes.

    To better investigate topical ?-blockers’ short-term efficacy and safety, a recent randomized clinical trial compared topical timolol maleate ophthalmic solution 0.5% with placebo eyedrops for acute migraine attacks. The crossover trial included 50 patients with migraine, randomized to receive either timolol eyedrops or a placebo . The three-month treatment period was followed by a one-month washout. After the washout, patients received the opposite treatment for another three months.

    The 50 patients suffered a total of 619 migraine attacks during the study, of which 284 were treated with timolol, 271 with placebo and 64 occurred during the washout period and received no study medications. Seven patients withdrew from the trial after randomization.

    The researchers found that 233 timolol-treated migraine attacks were associated with a reduction in pain score by four points, or to zero, after 20 minutes, compared with the 38 placebo-treated attacks. Overall, the pain score reduction after 20 minutes was significantly greater in the timolol group.

    Kurian A, Reghunadhan I, Thilak P, et al. Short-term efficacy and safety of topical ?-blockers in acute migraine: A randomized crossover trial. JAMA Ophthalmology. October 1, 2020. .

    How Does Propranolol & Other Beta Blockers Work For Migraines

    While the medical community is still working to understand more about migraines and how exactly propranolol and other beta blockers can prevent them. The most commonly accepted theory currently is that by relaxing the body’s body vessels and altering the flow to the brain, beta blockers can improve blood flow to your brain and thus reduce the risk of developing a migraine headache.

    What Are The Side Effects Of Ace Inhibitors And Beta Blockers

    ACE Inhibitors

    ACE inhibitors are well-tolerated by most individuals. Nevertheless, they are not free of side effects, and some patients should not use ACE inhibitors. ACE inhibitors usually are not prescribed for pregnant women because they may cause birth defects.

    Individuals with bilateral renal artery stenosis may experience worsening of kidney function, and people who have had a severe reaction to ACE inhibitors probably should avoid them.

    The most common side effects are:

    • Cough

    Beta Blockers: How They Work Types Benefits & Side Effects

    March 29, 2020

    According to the Centers for Disease Control and Prevention, a whopping 70 percent of adults over the age of 65 living in the United States take at least one type of heart medication every day. Among the most commonly prescribed types include beta blockers, which are used by millions of Americans to manage a variety of conditions — including high blood pressure, irregular heartbeats and chest pains.

    Researchers at Harvard Medical School have referred to beta blockers as “cardiac jacks of all trades.” So what are beta blockers, and what do they do exactly?

    These drugs work by blocking receptors in the heart and elsewhere that control blood flow and the release of certain hormones, including adrenaline. Interestingly, beta blockers actually have some similar effects as exercise on the cardiovascular system, including lowering your heart rate , reducing your blood pressure and even protecting against anxiety.

    They are also believed to help save lives, thanks to their ability to reduce recurrent heart attacks.

    What Are Possible Side Effects Of Taking Beta Blockers

    While beta blockers are generally considered safe, like many medications, there are potential side effects, and you should always consult your doctor before stopping treatment.

    Some of the common side effects include:

    • depression
    • insomnia, sleep problems, nightmares, and vivid dreams
    • memory problems
    • reduced ability to exercise
    • weight gain

    You should immediately contact your doctor if you experience signs of serious allergic reaction, dizziness, or difficulty breathing while taking these medications.

    Propranolol For Migraine Prevention: A Complete Guide

    GuidesEditorial Staff

    Those who struggle with migraines understand that they can be absolutely debilitating and have a huge negative impact on your day to day quality of life. While many people have infrequent bouts with migraines, some have to endure long term migraines that can last for days and come on without warning or apparent cause. While there are multiple medication types used to treat and prevent migraines, beta blockers are a common choice due to their ability to prevent migraines from occurring in the first place with a relatively benign side effect profile.

  • Cgrp Monoclonal Antibodies For Vestibular Migraine

    What are beta blockers and how do they work?

    People with VM were excluded from the trials of anti-CGRP Migraine treatments so not much is known about their efficacy as a Vestibular Migraine treatment, yet Dr. David Dodick remains “cautiously optimistic” about them for the future.

    For Dr. Shin Beh, some initial success is being seen among dizzy patients. He says, “I’m finding that the CGRP monoclonal antibodies are helping Vestibular Migraine patients. I have a handful of patients on them at the moment. With more people using them, I’m sure we will draw a much clearer picture. For the Migraine rescue oral CGRP small-molecule blockers , I am waiting to hear back from the patients on their efficacy. They are still pretty new to the market, and I suspect insurance companies are still figuring out how to deal with them.”

    Tricyclic Antidepressants For Vestibular Migraine

    Another popular class of medication used to treat Vestibular Migraine is tricyclic antidepressants. Nortriptyline specifically was found to relieve dizziness in 46% of patients who combined the medication with lifestyle changes that included addressing triggers related to diet, behavior, and sleep hygiene

    It seems these medications work well for patients who may also have sleep disturbances or who also experience an anxiety component to their attacks. It also appears that medication is even more effective when supported by other areas of treatment, like keeping a sleep schedule and avoiding potential food triggers.

    Vestibular Migraine Not As Rare As Once Thought

    Vestibular Migraine was once considered rare, but it is increasingly becoming a more widely recognized diagnosis. This type of Migraine is characterized by vertigo and dizziness. It is a common cause of headache with dizziness, but VM can occur with or without head pain.

    Migraine-associated vertigo affects between 1-3% of the general population, making Migraine the leading causes of vertigo and dizziness in adults

    Only about half of all patients with VM experience pain with their attacks. It can be confusing to get a diagnosis of Migraine if you have no pain, but an accurate diagnosis is key to finding the right treatment – and relief.

    How To Cope With Side Effects Of Propranolol

    What to do about:

    • feeling tired, dizzy or light-headed – as your body gets used to propranolol, these side effects should wear off. If propranolol makes you feel dizzy, sit or lie down until you feel better. Try to avoid alcohol as it will make you feel worse.
    • cold fingers or toes – put your hands or feet under warm running water, massage them and wiggle your fingers and toes. Do not smoke or have drinks with caffeine in – this can make your blood vessels narrower and further restrict blood flow to your hands and feet. Try wearing mittens and warm socks. Do not wear tight watches or bracelets.
    • difficulties sleeping or nightmares – try taking your propranolol in the morning. If you have to take it more than once a day, speak to your doctor. They may be able to change your propranolol to the slow release form.
    • feeling sick – stick to simple meals and do not eat rich or spicy food. It might help to take your propranolol after a meal or snack.

    Symptoms And Features Of Vestibular Migraine

    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
    • .

    What Are The Possible Side Effects Of Beta

    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.

    Articles On Migraine & Headache Prevention

    It’s the best situation: Stop a migraine before it starts. To do that, your doctor may consider these types of prescription drugs.

    Anticonvulsants. These are medicines that prevent or reduce seizures. Your doctor may recommend or valproic acid to prevent headaches. Anti-seizure drugs could make you sleepy. You may also find it harder to focus.

    Beta-blockers. These relax your blood vessels. They’re often prescribed to control blood pressure. For migraines, your doctor may suggest atenolol , , nadolol , propranolol , or timolol. Side effects include feeling depressed and having problems during sex.

    Botulinum toxin . A doctor can inject small amounts around your face and scalp every 3 months to keep migraines from happening. This treatment is approved only for people who have headaches at least 15 days a month. The more often you have migraines, the better Botox seems to help.

    Calcium-channel blockers. These include diltiazem and verapamil . They ease the narrowing of your blood vessels and are also given to treat heart disease. Side effects can include constipation and low blood pressure.

    Acute Medications For Vestibular Migraine

    Triptans are the ‘gold-standard’ for acute Migraine treatment, but, until recently, they were believed to provide little benefit as a Vestibular Migraine treatment.

    Triptans still have not been widely tested in VM so the verdict is still unclear. In a very small study of 10 participants, those who were given zolmitriptan showed some improvement in vertigo symptoms . The study was determined to be inconclusive, however, due to the small sample size

    In another study, patients with a history of headaches and dizziness showed improvement after taking rizatriptan preventatively for motion sickness

    Recently, Dr. Shin Beh, a specialist in Vestibular Migraine and the founding director of University of Texas Southwestern’s Vestibular Neurology and Neuro-Visual Disorders Clinic, reported in an interview that he has seen a positive impact with triptan use for acute treatment in some of his patients, but more trials are needed

    Still, the use of vestibular suppressants such as antihistamines, like meclizine, and some benzodiazepines continue to be popular and effective acute treatments for dizziness and vertigo.

    If meclizine proves to be ineffective, lorazepam , diazepam , and clonazepam are the next steps in acute treatments for dizziness relief. These drugs do come with a risk of addiction, which can be avoided by using the lowest possible dosage

    While antihistamines and benzodiazepines could be helpful for patients who experience anxiety, a large downside is the sedative side effect.

    Important Information About All Medicines

    Pin on Health & Nutrition

    Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital at once. Take the container with you, even if it is empty.

    This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

    Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

    If you have any questions about this medicine ask your pharmacist.

    Further reading and references

    Which Beta Blocker Is Best For Migraines

    Wondering how to choose between propranolol and metoprolol? Even though they’re both beta blockers, they work a little differently. For example, propranolol impacts more receptors in your brain.

    That’s not to say that it works better than metoprolol though—they’re equally effective and they have similar side effects. But, like many other migraine medications, that doesn’t mean both will affect you in the same way .

    The bottom line is the best beta blocker is the one that works best for you.

    We know this is a lot of information and you may still have questions. That’s why we work with licensed physicians to help each and every person find a treatment plan that works for them. If you’d like to speak to a Cove physician about your headaches, simply .

    If you’d like to keep exploring your options, we recommend reading about other migraine treatments, such as: triptans, NSAIDs, anticonvulsants, and antidepressants.

    The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

    Can You Drink Alcohol While Taking Beta

    It’s best to avoid drinking alcohol if you take beta-blockers.

    Both beta-blockers and alcohol can lower your blood pressure. Combining the two could cause your blood pressure to drop too quickly. This could leave you feeling weak, dizzy, or lightheaded. You might even faint if you stand up too fast.

    Of course, these side effects depend on both your prescribed dose of beta-blockers and how much you drink. While there’s no completely safe combination, having an occasional alcoholic drink may be less risky. But it’s best to check with your doctor first.

    You should also talk with your doctor if avoiding alcohol is difficult for you. Other medications may be available.

    Beta-blockers aren’t for everyone. They may pose a greater risk to people with the following conditions:

    • asthma, COPD, and other lung diseases

    Talking to your doctor about your health and any medical conditions may help you avoid negative side effects.

    • Let your doctor know if you’re pregnant, trying to get pregnant, or breastfeeding.
    • To prevent drug interactions, provide your doctor with a list of all the medications and supplements you take.
    • Be honest about your alcohol, tobacco, and drug use. These substances can interact with beta-blockers.

    Migraines: Stop Them Before They Start

      ARCHIVED CONTENT: As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date each article was posted or last reviewed. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. 

      In her compelling essay, “In Bed,” novelist Joan Didion wrote, “That no one dies of migraine seems, to someone deep into an attack, an ambiguous blessing.”

      For many people, migraines are debilitating events. As Harvard Health editor Christine Junge wrote in this space last year about her battle with migraine:

      “On the good days, the pain was just a mild throbbing sensation. Other times, there was a general sense of an ever-tightening pressure. On the days when I couldn’t get out of bed, it felt like someone was tightening screws into the sides of my head and pounding a hammer above my left eye. The pain never went away, unless I was asleep.”

      Most migraine sufferers long to prevent these painful episodes. As I write in this month’s Harvard Health Letter, about one-third of migraineurs could benefit from taking a preventive pill. But only a minority of them actually take advantage of this option. New treatment guidelines from the American Academy of Neurology and the American Headache Society profile the best preventive medications, and an herbal preparation, for 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:

      How Does A Beta Blocker Help Migraines


      It can take around three months to determine effectiveness. That can feel like a very long time in which you have little control, which is why we suggest looking into both prescription pain relief medication and research-backed home remedies.

      Furthermore, how effective are beta blockers for migraines? A network analysis suggested that betablockers‘ benefit for episodic migraines may be a class effect. For chronic migraine, propranolol was more likely to reduce headaches by at least 50% . The effect began as early as 4 weeks, with migraines reduced by an average of 1.3 headaches per month.

      Keeping this in view, what does propranolol do for migraines?

      Propranolol belongs to a group of drugs called beta blockers. It is used in patients with heart problems to control high blood pressure or irregular heart beats. It is also used to treat certain types of vascular birthmarks. It is also used to prevent migraines and headaches.

      Do beta blockers cause migraines?

      High Blood Pressure and Heart DrugsFor instance, betablockers, which doctors often prescribe to control blood pressure, can also slow down the brain cells linked to migraine. These include: Atenolol

      Can Propranolol Treat Active Headaches

      While propranolol can be an effective tool to prevent migraine attacks from coming on, there is little support to show they are effective at reducing immediate symptoms of acute headaches in the short term. There are better options to consider to treat actively occurring migraines, propranolol should be used preventively rather than as a reactionary measure when you notice a migraine coming on.

      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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