100 Migraine Drugs, A to Z: metoprolol

Metoprolol (Toprol) is one of the beta-blockers, drugs used for the treatment of hypertension and other heart conditions. It is one of the three beta-blockers (the other two are propranolol and timolol) that are included in the American Academy of Neurology guidelines for the preventive treatment of migraines.

A large double-blind study showed that metoprolol (200 mg/day) was more effective than aspirin (300 mg/day) in achieving 50% migraine frequency reduction (45% vs 30%). No significant side effects were reported in either group.

A small study reported that metoprolol (50–150 mg/day) had similar efficacy to nebivolol (another beta-blocker), 5 mg/day in reducing migraine attacks.

Metoprolol, unlike propranolol and timolol, is a selective beta-blocker, which means that it has a much lower chance of triggering an asthma attack in those who suffer from asthma or prone to occasional asthma attacks.

Some of the side effects that can occur with all beta blockers, including metoprolol, are tiredness., dizziness, constipation, blurred vision, chest pain, slowing of the heart rate, which can interfere with aerobic exercise, and other. Migraines are most common in young women many of whom have low blood pressure, which makes them more likely to develop dizziness and tiredness. It can also interfere with the best preventive treatment of migraines – regular exercise.

I reserve beta-blockers for those with normal or high blood pressure, those with rapid heart beat, and anxiety. It helps physical but not mental manifestations of anxiety – sweating, shaky voice, and fast heart rate. Beta-blockers are proven to help and are often taken in small doses for performance anxiety before giving a speech, presentation, or musical performance.