100 Migraine drugs, A to Z: Atenolol

Atenolol (Tenormin) is a blood pressure medicine in the beta blocker family. Atenolol is considered to be equally effective in preventing migraines to propranolol (Inderal), which was the first drug to be approved for the prevention of migraines over 50 years ago. The effect of atenolol lasts all day and it can be taken once a day. It has the same side effect profile as propranolol. The most common side effects are caused by excessive lowering of blood pressure or slowing of the pulse rate and include fatigue, lightheadedness, exercise intolerance, cold extremities, and occasionally impotence, depression and insomnia. Some but not all beta blockers can worsen asthma.

You do not have to have high blood pressure to take atenolol or another beta blocker – they prevent migraines even if blood pressure is normal. We still do not know how these drugs prevent migraines. We do not prescribe beta blockers if the blood pressure is low (below 110/70) because the risk of side effects is high. However, if the blood pressure is in the middle of normal range or higher, this is a good choice. Beta blockers also help with anxiety and many performers take them only before giving a speech, a presentation, or a musical performance. Under these circumstances, a short-acting beta blocker, such as propranolol is a better choice than atenolol. Beta blockers are also very effective for the benign essential or familial tremor.