100 Migraine Drugs, A to Z: propranolol
Propranolol (Inderal) belongs to the beta-blocker family of medications and it was approved by the FDA in 1967 for the treatment of high blood pressure. About a decade later it became the first drug to be approved by the FDA for the preventive treatment of migraine headaches. Propranolol is also used for essential tremor, performance anxiety, fast heart beating (tachycardia), angina, and other conditions. In 1988, a British scientist Sir James Black was awarded the Nobel Prize for the discovery of propranolol.
Propranolol is a very effective drug, but because it can lower blood pressure, side effects such as fatigue, lightheadedness, and fainting can occur. Because it slows down the heart rate it can also make it difficult to exercise, which is one of the best ways to prevent migraines. Propranolol can sometimes worsen pre-existing asthma but newer beta-blockers do not have this problem.
If someone along with migraines has a rapid heartbeat, anxiety, or difficulty making public presentations, this drug can provide dual benefits.
A typical starting dose of propranolol is 60 mg of the long-acting formulation. The dose is then increased to 80, 120, and 160 mg, if needed and if tolerated.
Usually, but not always, taking an immediate release drug more frequently will provide the same effect as taking a long-acting drug.
Hi Dr. Mauskop, Do you have an opinion on whether generic propranolol in divided doses works any differently than the brand name Inderal-LA which is slower acting. Would any side-effects be the same.
Thank you
No, I have not had anyone try nasal spray of a beta blocker.
Hi Dr. Mauskop, I’m wondering if you have patients who have tried the nasal spray beta-blocker and if there have been positive results, and what your thoughts are on this method for both acute and chronic migraine. Thank you so much!
Yes, sometimes lower doses are effective. Depending on the final dose it can take a couple of weeks or a couple of months before full benefit is achieved.
I have a few questions about propranolol please. How long does it take propranolol to begin to start working as a prophylaxis for migraines? I know you list the dose is usually started at 60 mg a day, but have lower doses proven effective for migraine? Thank you
Beta blockers (BB) are traditionally used in migraines for ‘preventive’ therapy for people with a significant number of migraines weekly, not well controlled with ‘acute’ migraine therapy. BB pills taken daily (chronic therapy) are a mainstay of preventive therapy. BB pills have been tested and do not work for acute migraine. Research I have done shows the reason is by pill form it takes too long for the BB pill to achieve therapeutic blood levels. BB are now available on prescription by compounded nasal spray. I have over 100 successfully treated patients. I have discussed this treatment with Dr. Mauskop. The nasal spray is available from O’Brien Pharmacy and cost about $35 plus postage. Discuss this with your doctor or Dr. Mauskop. This is a LINK to our research: https://ijpc.com/Abstracts/Abstract.cfm?ABS=4787