100 Migraine Drugs, A to Z: timolol

Timolol (Blocadren), is the second of the two beta-blockers approved by the FDA for both hypertension and the prevention of migraines. Among the dozen or so beta-blockers, it is not very popular for either hypertension or migraine. An ophthalmic solution of timolol is often used for glaucoma.

A study of 107 migraine patients compared prophylactic treatment with timolol, 20 to 30 mg per day with matching placebo. The study was a double-blind crossover study that lasted 20 weeks. Timolol was significantly better than the placebo in decreasing the frequency of headaches, numbers of patients who had a 50% reduction in headache frequency, global response, and patient preference. The overall response was 65% with timolol compared with 40% with placebo. The severity and duration of headaches that occurred were unchanged. Few side effects were reported with either timolol or placebo.

Another study compared timolol, 10 mg twice a day with propranolol, 80 mg twice a day, and with placebo in 83 migraine patients. Timolol and propranolol were equally effective and had a similar rate of side effects.

The side effects of timolol are typical of all beta-blockers – chest discomfort, tiredness, lightheadedness, dizziness, fainting, shortness of breath, slow or irregular heartbeat.

The usual dose of timolol is 10 mg twice a day.

You can read about the use of timolol eye drops to treat acute migraines in a previous post.