You and your healthcare provider can decide whether you need to take a prophylactic migraine medication based on the frequency of your migraines, how long they last, how many migraine days you have per week or month, and whether they improve with abortive treatment (treatment used at the time of an acute migraine attack).
How They Work
Beta-blockers are taken on an everyday basis to reduce blood pressure, and they are also used daily when recommended for migraine prevention.
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Beta-blockers relax blood vessels throughout the body, which is why they are used for the management of hypertension. They exert this effect by acting directly on β-adrenergic receptors, which are located in the wall of blood vessels.
Beta-blockers have several actions that may help in reducing migraines. Among them:
Beta-blockers reduce cerebral (brain) blood flow by directly acting on the blood vessels in the brain. Vasodilation (widening of the blood vessels) is associated with migraines. They induce a change in the electrical activity of the brain, preventing an effect described as cortical spreading depression—a type of slow brain activity associated with the early stages of migraine. These medications may also increase activity in the hypothalamus, a region of the brain that has been associated with migraines.
It isn’t completely clear which of these effects occurs first or which has the most powerful impact on reducing migraines, and it is likely that a combination of these actions is responsible for the effect on migraine reduction.
Options
There are a number of different beta-blockers, but they are not all used for migraine prevention. The most common beta-blockers used for migraine prevention are:
Inderal (propranolol): Studies show propranolol is effective in reducing the frequency of migraines for both adults and children. Inderal is taken at a dose of 120 to 240 mg per day for migraine prevention. Blocadren (timolol): This beta-blocker regulates serotonin to prevent migraine symptoms, including aura and light sensitivity. Blocadren is taken at a dose of 20 to 40 mg per day for migraine prevention. Tenormin (atenolol): Atenolol is known to cause fewer side effects than other beta-blockers. For migraine prevention, a single dose of 50 to 100 mg is taken per day. Corgard (nadolol): Minimal side effects are associated with nadolol as well. The American Headache Society recommends a single dose of 40 to 60 mg per day for migraine prevention.
Secral (acebutolol), Trasicor (oxprenolol), and Visken (pindolol) are beta-blockers that work a little differently and are not considered effective in migraine prevention. In addition, if you are already taking a beta-blocker for hypertension, this does not automatically mean that it will prevent your migraines.
Your healthcare provider will determine the right beta-blocker and dose for you based on factors such as your medical history and the other medications you are taking.
Side Effects
There are some side effects of taking a beta-blocker. Because they reduce blood pressure, they can cause hypotension (low blood pressure), which may result in lightheadedness, confusion, or loss of consciousness. This is not common, but you should be aware of the possibility of hypotension when taking an antihypertensive.
Other side effects of beta-blockers include:
FatigueReduced exercise toleranceNauseaDizzinessInsomniaDepression
Interactions
You may experience adverse effects if you take beta-blockers along with other blood pressure medications, asthma medications, or barbiturates, such as Fioricet (butalbital/acetaminophen/caffeine) or Fiorinal (butalbital/aspirin/caffeine).
It is important to tell your healthcare provider and pharmacist about all of the medications you take, including any over-the-counter medications, vitamins, or supplements. Even herbal supplements can have actions that interact with prescription medications such as beta-blockers.
Contraindications
If you have certain medical conditions, beta-blockers can exacerbate them. You might not be able to tolerate beta-blockers if you have heart block, asthma, low blood sugar, Raynaud’s phenomenon, or vascular disease. Beta-blockers may also worsen depression.
A Word From Verywell
There are a number of strategies used for migraine prevention. Daily prescription medications such as beta-blockers are most effective when combined with other preventative approaches, such as stress management and avoiding triggers.
Be sure to discuss any side effects with your healthcare provider and be observant of your migraine frequency after you start beta-blockers so that you can assess if (and how well) they are working.
