A guide to propranolol for migraine

Propranolol is a prescription medication that affects your heart. It can help regulate your heartbeat and reduce how hard your heart works. It does this by blocking the effect of certain hormones on your heart, such as adrenaline.

Doctors usually prescribe it to treat heart-related conditions like easing chest pain or following heart attacks. But it’s also used as a preventive migraine treatment.

Knowing more about propranolol for migraine can help you feel confident in your treatment.

Propranolol for migraine

Migraine is a condition that can cause severe symptoms, most commonly a headache on one side of the head, aura (which can present as vision changes like flashes of light), and light or sound sensitivity.

These usually occur as migraine attacks that can last for up to 3 days. Migraine affects your quality of life, particularly if you experience frequent or long lasting attacks.

Propranolol for migraine is what’s medically known as a prophylactic treatment, meaning doctors prescribe it to prevent migraine attacks rather than treat the symptoms when they occur or cure the condition. How it works exactly is unclear, but it likely affects the blood vessels in your brain.

It would be best if you only took propranolol as directed by a doctor.

Research suggests that propranolol is effective in reducing the frequency of migraine attacks, and it may be more effective at this than other beta-blockers like metoprolol or bisoprolol. Apart from reducing the number of headaches, the same research suggests that propranolol can reduce the severity of attacks and how long they last.

How long does it take to work?

Propranolol is a preventive treatment rather than a medication for treating symptoms, so it may take some time for you to notice the effects. Research on the effectiveness of propranolol in reducing migraine attack frequency saw results after 8 weeks.

However, some experts suggest that it can take up to 12 weeks to notice the benefits, and it may take even longer if you need to try different doses to find which works best for you. The starting dose is usually 40 milligrams (mg), and the maximum is 320 mg per day.

Possible side effects

Although some research suggests that propranolol has better tolerability than other migraine preventive medications, there is still a possibility that you may experience side effects. The most common ones include:

• dizziness
• nausea
• sleepiness or fatigue
• breathing problems
• slow heart rate
• low blood pressure
• depression

You should not use propranolol if you:

• have diabetes
• have bradycardia (slow heart rate)
• have lung conditions like asthma or emphysema

What’s more, if you’re pregnant, doctors recommend practicing caution. The Food and Drug Administration (FDA) has classified propranolol as a category C medication, which means there’s a possibility of risk due to a lack of research. But there is no evidence that it will have negative effects.

Other treatments

You might find that propranolol isn’t right for you, either because of side effects or because you don’t see any benefits. If this is the case, there are other options you can try.

Other preventive medications

Alongside propranolol, other medications can help prevent migraine attacks. These include:

• Other beta-blockers: These include timolol (Blocadren), atenolol (Tenormin), and metoprolol (Lopressor).
• Anticonvulsants: Divalproex (Depakote) is a common medication for migraine prevention, and topiramate (Topamax) shows similar effectiveness as propranolol.
• Antidepressants: Examples include amitryptiline (Elavil), fluoxetine (Prozac), and venlafaxine (Effexor).

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Migraine treatment

Preventive migraine treatments are not a cure for migraine. Even if you take them, you are likely to still experience occasional attacks. Other medications, known as acute or abortive, are available that can actively treat these attacks.

• Triptans: These are the first-line migraine treatment medications, which include almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig).
• Over-the-counter (OTC) pain relievers: Doctors recommend these to treat the pain you may feel during a migraine headache and include ibuprofen (Advil) and acetaminophen (Tylenol).
• Ergot derivatives: These are the second-line treatment if first-line medications don’t work. Examples include ergotamine (Cafergot) and dihydroergotamine.
• Antiemetics: Also known as anti-sickness medications, these are other second-line treatments. Examples include prochlorperazine (Compazine) and metoclopramide (Reglan).
• Gepants: These are also second-line treatments, which include rimegepant (Nurtec) and ubrogepant (Ubrelvy).

Lifestyle measures

As well as medications, you may want to use some lifestyle strategies to prevent or treat migraine. These include:

• avoiding known triggers
• being mindful of your diet
• keeping a regular sleep-wake schedule
• limiting alcohol (if you drink) and caffeine intake
• getting regular exercise
• trying cognitive behavioral therapy to reduce stress

Summary

Propranolol is a type of medication called a beta-blocker that affects your heart. It’s a common preventive treatment for migraine. Research shows it’s effective at reducing the frequency and severity of migraine attacks, but doctors don’t commonly prescribe it for active migraine.

You may want to combine preventive treatments like propranolol with acute treatments if you have a migraine attack. The most common combinations are triptan medications and OTC painkillers. You might also consider trying lifestyle measures like avoiding triggers and limiting your alcohol intake (if you drink).

It would be best to be mindful that propranolol comes with a risk of side effects, although generally, side effects are rare. If you have any concerns, speak with a healthcare professional. They can help you find a migraine treatment that is right for you.

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