100 Migraine Drugs, A to Z: nebivolol

Nebivolol (Bystolic) is one of the newer, third generation beta-blockers, drugs used for the treatment of high blood pressure as well as migraine headaches. In Europe, it’s been in use for over 20 years.

In addition to beta-blockade, it may have additional beneficial effects on endothelium (blood vessel lining). It may also improve glucose metabolism by improving insulin sensitivity and other functions.

Nebivolol has the advantage of having fewer side effects than other beta blockers. including lower rates of fatigue and shortness of breath.

The majority of migraine sufferers are young women, many of who have low blood pressure, which predisposes them to side effects from beta blockers.

However, in the US, nebivolol is relatively expensive ($160 for one month supply) since it is not yet available in a generic form. Many insurers will not pay for it unless the patient cannot tolerate the widely used and inexpensive beta blockers such as propranolol, metoprolol, or atenolol.