Beta Blockers For Migraine: All You Need to Know About Managing Migraines With Beta-Blockers

About 30 million people¹ in the US suffer from migraine headaches each year. Of these people, 11 million have moderate to severe symptoms.

The neurological disorder is responsible for loss of productivity and substantial medical costs in the US each year.

Migraines can cause pain, frustration, and disruption to your daily life, but finding effective treatment to ease your symptoms can be challenging.

Scientists do not yet have a cure for migraine, but there are treatment options that can help prevent or reduce the frequency and intensity of your symptoms. 

What is a migraine?

A migraine is a type of headache that can cause intense throbbing pain on one side of the brain, lasting for a few hours or days. The pain can be so severe that it interferes with your normal activities. 

Not everyone gets a headache when they have a migraine. This type of migraine is called “silent migraine.”

Migraines can sometimes be accompanied by other symptoms, including:

• Nausea

• Vomiting

• Light and sound sensitivity

• Numbness

Treatment options involve pain relievers and preventative medication. Your doctor may prescribe beta-blockers to help prevent your migraine attacks.

What are beta-blockers?

When first introduced in the 1960s, beta-blockers were used to treat various heart conditions.

Beta-blockers help block the production of angiotensin II. Angiotensin II causes your blood vessels to constrict temporarily. This can increase your blood pressure. When beta-blockers stop angiotensin II from acting, your blood vessels relax, and your blood pressure goes down. This makes it easier for your heart to pump blood around your body.

Beta-blockers also work by altering how adrenaline hormones affect your body. This causes your heart to beat more slowly with less pressure, which lowers your blood pressure.

Doctors realized that beta-blockers could also help treat migraines when various patients reported the drug alleviated their migraine symptoms. However, beta-blockers were not approved for migraine treatment by the Food and Drug Administration (FDA) until the 1970s.

Beta-blockers treat migraines by reducing pain and the frequency of migraines and other types of headaches.

Doctors recommend the drugs because there is a connection between high blood pressure (hypertension) and headaches. Not only can beta-blockers help manage your high blood pressure, but they can also ease pain and prevent future migraine attacks.

Beta-blockers can still help people without hypertension.

Besides treating migraines and hypertension, beta-blockers can also:

• Control the widening and constriction of blood vessels

• Block movement of pain in the body

• Affect the serotonin chemical in the body

Common types of beta-blockers

Beta-blockers are prescription-only medications. You can only obtain them with a doctor’s prescription — you cannot buy them over the counter.

Not all beta-blockers can treat migraines, but the following have been proven to effectively prevent migraines:

• Propranolol (Inderal LA, Inderal XL, or InnoPran XL)

• Atenolol (Tenormin)

• Metoprolol (Lopressor)

• Timolol

None of these drugs were initially designed for migraine treatment, but they have been approved for this purpose over the years.

How beta-blockers help prevent migraines

Doctors are not entirely sure how beta-blockers help treat migraines. However, they are thought to block a set of changes that trigger migraines.

Here are the possible ways beta-blockers help prevent migraines:

Preventing anxiety

The FDA approved beta-blockers to treat anxiety, which is a known migraine trigger.

When your body is in a state of panic, it produces adrenaline hormones, also known as epinephrine. This activates your “fight or flight” reaction. However, your body may produce adrenaline even when there is no perceived threat. This is known as “adrenaline anxiety.”

Beta-blockers change the way your body responds by reducing the effects of adrenaline hormones in the body.

Restricting the flow of blood in the brain

Adrenaline hormones constrict your blood vessels when they are released into your bloodstream. When this happens, the blood flow to your brain fluctuates, resulting in migraines.

Beta-blockers reverse this effect, allowing your heart to pump at a normal rate.

Helping prevent stress

Stress can trigger or worsen headaches and migraines. Beta-blockers help block the effects of stress hormones produced in your body when you are stressed: epinephrine and adrenaline.

Who should take beta-blockers for migraine?

Your migraine treatment plan will depend on a few things:

• How often you get migraines

• The severity of your migraines

• Types of medications you have used to treat migraines in the past

Doctors believe beta-blockers are one of the best ways to treat episodic migraines (those that occur less than four times a month). However, your doctor may still prescribe beta-blockers if you have chronic migraine headaches (those that occur more than 15 times per month).

Your doctor may recommend beta-blockers if you have the following conditions:

• High blood pressure

• Chest pain (angina)

• Extreme anxiety

• Fast heart rate (tachycardia)

Most adults and children over the age of 12 can take beta-blockers. The drugs have not been approved to treat hypertension in children younger than 12 years. 

Not everyone can take beta-blockers. Your doctor will consider your medical history before prescribing the drugs. However, if you have any of the following conditions, your doctor won’t prescribe you beta-blockers:

• Asthma

• Diabetes

• Chronic obstructive pulmonary disease (COPD)

• Low blood pressure (hypotension)

• Heart rhythm issues, such as AV-block or sick sinus syndrome

• Raynaud’s disease

• Metabolic acidosis

• Liver or kidney problems

Beta-blockers are also not suitable if you are pregnant or breastfeeding.

Don’t stop your beta-blocker treatment suddenly or without consulting your doctor. Doing so could cause your heart rate to increase.

Which beta-blocker is best for migraines?

The best beta-blockers for migraines are metoprolol (Lopressor), nebivolol (Bystolic), propranolol (Inderal LA, Inderal XL, or InnoPran XL), and timolol.

A study² conducted on randomized patients with a history of migraines showed metoprolol and nebivolol effectively reduced the frequency of migraine attacks after about four weeks.

Propranolol is commonly prescribed to prevent migraine. According to the American Academy of Neurology,³ this drug is highly effective.

How to take beta-blockers for migraine

You should take beta-blockers exactly as your doctor prescribed them. Some can be taken by mouth, while others are injected. Swallowing a tablet is the most common way to take these drugs. You should take the drugs up to twice a day.

Studies⁴ have shown different doses of propranolol can effectively treat high blood pressure. To treat migraines, doctors prescribe a 20mg dose, taken up to four times a day. In some cases, your doctor may increase your dose up to 240mg per day.

If you miss a dose of your beta-blocker, take it as soon as you remember. Don’t take a missed dose if more than four hours have passed. Instead, skip the missed dose and resume your regular schedule. Don’t take a double dose to make up for the missed dose.

Beta-blockers can take four to six weeks to start working. When they start working, you will notice getting migraine attacks less frequently. Research⁵ shows that migraine attacks are reduced by half when taking beta-blockers.

Questions to ask your doctor before taking beta-blockers

Before taking beta-blockers for migraine, ask your doctor these questions:

• How long do I have to take these drugs?

• Can taking beta-blockers affect my health?

• How much exercise do I need to do when taking beta-blockers?

• Will the drugs interfere with my normal activities?

• Will I need to avoid certain foods when taking beta-blockers?

• Will beta-blockers make me gain weight?

Common side effects of beta-blockers

Many people who take beta-blockers experience very mild symptoms or none at all.

Common side effects of beta-blockers include:

• Feeling tired

• Weight gain

• Cold fingers or toes

• Nightmares

• Difficulty sleeping

You should talk to your doctor if any of these symptoms last for days or make you uncomfortable.

Tell your doctor if you also experience the following:

• Shortness of breath

• Coughing that gets worse after exercise

• Wheezing and chest tightness

• Yellowing skin or eyes

Your doctor must know if you are taking any other medications. Beta-blockers can interact with other drugs, including:

• Insulin

• Antidepressants

• Cholesterol-lowering drugs

Avoid alcohol when taking beta-blockers, as the combination can lower your blood pressure to dangerous levels.

Other options for migraine treatment

Migraine treatment can ease symptoms and prevent migraines.

Scientists have discovered various medications to help treat migraines. The drugs fall into two categories:

• Pain-relieving drugs: designed to stop symptoms when they appear

• Preventive drugs: taken every day to reduce the frequency of migraines

Your doctor will recommend medications depending on your symptoms and how severe they are. Treatment will also depend on any other health conditions you have.

Pain-relieving drugs

You can take pain-relieving medication when you feel a migraine starting. Such medications include:

• Over-the-counter (OTC) pain relievers: OTC medications include aspirin, acetaminophen (Tylenol and Panadol), or ibuprofen (Advil, Motrin, and others). Don’t take these drugs for too long as they can cause medication-overuse headaches.

• Triptans: These drugs are used to block pain pathways from the brain. Triptans include sumatriptan (Imitrex or Tosymra) and rizatriptan (Maxalt). Avoid triptans if you are affected by stroke or type 2 diabetes.

• Dihydroergotamine (DHE 45 injection or Migranal nasal spray): take this drug shortly after the onset of a migraine that lasts for more than 24 hours. Avoid this medication if you have heart disease or high blood pressure.

• Lasmiditan (Reyvow): A newer drug that has been shown to improve symptoms of migraines. Lasmiditan can help if you suffer from migraine with or without aura.

• Ubrogepant (Ubrelvy): This is a prescription drug designed to treat acute migraines with or without aura. Don’t take ubrogepant if you are taking strong CYP3A4 inhibitor drugs.

• CGRP antagonists: These drugs are FDA-approved to treat migraines. They include erenumab-aooe injection (Aimovig), galcanezumab-gnlm injection (Emgality), and fremanezumab-vfrm injection (Ajovy).

• Opioid medications: your doctor will only recommend narcotic opioid medications if you cannot take other migraine medications. Opioid medications are highly addictive, so your doctor will only prescribe them in certain cases.

• Anti-nausea drugs: If you are experiencing migraines with aura accompanied by nausea and vomiting, your doctor will recommend anti-nausea drugs such as chlorpromazine, metoclopramide (Reglan and Metozolv ODT), or prochlorperazine (Compro or Procomp) with pain relievers.

Preventive drugs

Your doctor may recommend preventive drugs if you have frequent migraine attacks that don’t respond well to pain relievers. The aim of this medication is to prevent migraine attacks from occurring.

Beta-blockers are a form of preventive medication, but other forms of treatment can help with migraines. They include:

• Antidepressants

• Anti-seizure drugs

• Botox injections given every 12 weeks

You can also try non-traditional therapies to ease migraine pains, such as:

• Acupuncture

• Cognitive-behavioral therapy

• Yoga or meditation

• Biofeedback

Living a healthy lifestyle is one of the best ways to avoid headaches and migraines. Making certain lifestyle changes can help prevent and reduce the intensity of migraine pain. Some of these lifestyle changes include:

• Quitting smoking

• Avoiding certain foods, such as aged cheese and chocolate

• Practicing good posture

• Reducing stress

• Eating a balanced diet and avoiding skipping meals

The lowdown

Beta-blockers are drugs used to treat heart-related conditions, such as high blood pressure. However, you can also take them to prevent migraines or ease your migraine symptoms.

Beta-blockers work by preventing blood vessel constriction, stress, and anxiety and stabilizing serotonin levels. These factors can all cause migraines.

When beta-blockers start working, you will notice your migraines occurring less frequently. They will also last for less time and be less severe.

Beta-blockers are not suitable for everyone. This type of medication can cause some side effects and interact with other medications. Talk to your doctor and ask questions before starting beta-blocker treatment.