beta blockers

17 August 2021

Searching for the “Weak Link” in Migraine

“Weak link” may work for a headline, but investigating and treating migraine is much more complex, because the body is incredibly complex. Think of a spider web. Or better, a whole city with all its roads and businesses and families.

At first, it may seem that widening a particular road is the answer. After all, a certain number of cars travel down this road, so if it were double the size, the traffic would flow much quicker. Right? Well, of course you know it’s not that simple. To widen the road, you take land from something else. You encourage more people to use that route. You spend months in construction, changing people’s habits.

So we hear about various drugs that have different effects on the body. A beta-blocker. CGRP inhibitors. Cox-2 inhibitors. They’re all trying to fix a certain street – not to simply improve the traffic on that road, but to fix a city-wide problem. Migraine symptoms.

There has been some interesting research recently on one of these “roads” in your body – hyperpolarization-activated cation channels (actually a family of proteins in the heart and nervous system). This particular communication path in your body has a lot to do with inflammation. In fact, if you check out this study from several years ago, you might notice several words familiar to the migraine world – inflammation, hypersensitivity, and the temporomandibular joint. That last one is your jaw joint – the joint and nerves in the face are often implicated in migraine related headache pain.

So if this channel is part of the system that communicates inflammation and neuropathic pain, would this be a good “road to repair” in order to fight migraine? And how would you test that hypothesis?

A study in Denmark is trying to do just that. How? Well, we already have a hyperpolarization-activated, cyclic nucleotide-gated (HCN) channel blocker, called ivabradine (sold under the brand names Corlanor, Procoralan, and others). So the study will be testing ivabradine, not necessarily as a future migraine treatment itself (although that may be the case), but to see how effective it is. If effective, researchers may look at developing this type of medication specifically for migraine use.

It is interesting that ivabradine is a heart medication. It’s currently used to slow the heart rate in patients with certain types of chest pain or heart failure. There are several other heart medications that are used for migraine – such as beta blockers (think of metoprolol, propranolol, and timolol). In fact, patients that don’t respond well to beta blockers are sometimes given ivabradine.

To read more about the hypothesis and theory behind this clinical trial, just go to the trial page and look specifically at the “Detailed Description” – The Effects of Ivabradine on Levcromakalim-induced Migraine (ILMO). To go deeper into HCN channels, this article is from a few years ago but will give you an introduction: Hyperpolarization-Activated Cation Channels: From Genes to Function

15 April 2019

Eye Drops for Migraine revisited – a low-cost treatment?

James Discoveries & Stats, Medications, Treatments 0

A few years ago we talked about a possible “$5” treatment for migraine – Timolol eye drops. Since then the price may have increased slightly, but researchers are still interested in the possibility that such an inexpensive treatment may work well for many migraine patients.

A new study published in JAMA Neurology investigated the eye drops as an abortive treatment. The timolol maleate 0.5% eye drops were given to migraine patients, to be used when a migraine attack hit. This was a “crossover study” meaning that the patients tried the Timolol and then tried simple eye drops, or vice versa, without being told which they were using.

The patients used a single drop in each eye at the beginning of an attack, and again after 30 minutes if needed.

Results? The Timolol drops were significantly better than placebo – almost twice as effective. 78% had very little pain after two hours, or no pain. Of course, some patients responded better than others. Several obviously responded very well, one patient immediately expressing the desire to replace their other migraine meds with the eye drops.

Of course, as with many studies like this, researchers still don’t know why some patients responded so much better than others. But once again, this has the potential to be a very effective and extremely inexpensive treatment for some patients.

Timolol is a beta-blocker, actually taken orally for migraine as well. But there may be a special benefit in the eye drops. The big $$$ may not be there for the big clinical trials, since this is such an inexpensive treatment. But take a look at the author’s thoughts on the study (below). It may be a treatment that is worth trying, under the supervision of your doctor.

23 May 2018

Female Sexual Dysfunction and Migraine and Headache Medications

James Uncategorized 0

Just how common is female sexual dysfunction? It’s a complicated question. Although it’s extremely common for women to report some kind of problem sometime, it’s a whole different question when you start asking about actual dysfunction and what that is.

Man and Woman But statistics aside, the problem is real, and in many cases it could be caused by your migraine or headache medication.

Migraine patients, and patients with various headache conditions, often have many symptoms to think about. And, of course, there can be many causes of sexual problems. It’s hard to know what to mention to your doctor, and with sexual activity that may be new or not regular, sexual dysfunction from medication may not be something easily recognized.

Medications can especially interfere with both desire and pleasure during sex. Common culprits include:

Antidepressants: Antidepressants are often prescribed for migraine prevention, even when the patient is not depressed. Common examples of these medications are amitriptyline (Elavil, Entrip, Triptaz, etc), nortriptyline (Pamelor, Allegron, etc), desipramine (Norpramin, Pertofrane, etc), doxepin (Sinequan, Sinepin, etc).
Beta-blockers: Another migraine preventative, beta blockers can cause problems with desire and orgasm, as well as vaginal dryness. Examples include propranolol (Inderal) and metoprolol (Lopressor, Toprol XL).
Calcium channel blockers: As with beta-blockers. Common examples are verapamil (Calaptin, Veramil etc) and nimodipine (Nymalize, Nimotop)
Anticonvulsants: Another migraine preventative. Anti epileptic drugs are commonly prescribed for migraine, and some may be worse than others when it comes to sexual dysfunction. Examples include valproate, topiramate, and divalproex sodium.

Although these are some common categories, there are a number of other drugs that may affect sexual function.

It’s worthwhile noting that many of these drugs will also cause problems for men, though often for different reasons.

If you’re concerned, talk to your doctor. There may be another similar medication that will control your migraine attacks but won’t interfere with sex.

3 December 2015

Atenolol for Vertigo – Is it Effective?

James Medications 0

Atenolol (brand name Tenormin) is a type of medication known as a beta blocker. Beta blockers are often used for cardiovascular diseases, such as hypertension (high blood pressure). But could it also be used for vertigo?

You won’t find atenolol for vertigo on most lists of medication for vertigo, and there are two reasons for that. But, as we will see, it is sometimes helpful in alleviating vertigo.

First, atenolol is not typically a medication used to suppress vertigo symptoms. In fact, beta blockers are not commonly thought of as vertigo treatments.

However, they are migraine treatments. That being said, atenolol is a less commonly prescribed migraine drug.

So atenolol is sometimes used to treat migraine – migraine with the symptom of vertigo. Treat the migraine, treat the vertigo.

However, you still won’t find it on most lists, because it’s not usually one of the first beta blockers to try.

Beta blockers that seem to be more effective for treating migraine (including migraine related vertigo) include propranolol, metoprolol and timolol. Atenolol also tends to be discouraged in pregnant women, seniors, and people with depression and diabetes (among other things).

The short answer is this: Medication for vertigo will depend on the cause of the vertigo. If the vertigo is related to migraine, your best bet is to treat the migraine disease itself. Beta blockers are an option (not necessarily the first option to try, however), and atenolol may be helpful. But your doctor will probably recommend you try other treatments first, before recommending atenolol for vertigo (for examples of higher rated treatments, including beta blockers, check out From Current Studies: What Migraine Treatments Work?).

For an overview of the drug treatments for vertigo, check Management of Dizziness and Vertigo. Also see Migraine-associated dizziness: patient characteristics and management options. and Atenolol in the prophylaxis of chronic migraine. Finally, here is a discussion including atenolol for vertigo in migraine.

3 October 2012

What You Need to Know about the Beta-Blocker Controversy

James Medications, News 0

Beta-blockers are all over the news today, thanks to the publication of a new study in the USA. The study was focused on patients with heart trouble, but there’s little doubt that it will impact migraine patients as well.

When it comes to heart disease, beta-blockers are prescribed in order to slow rapid heart beat and lower blood pressure. They’re often prescribed to patients who have a previous history of heart attack or stroke, to patients with high blood pressure, and to patients who have just had a heart attack or have heart failure.

And, as we’ll see, it’s prescribed for conditions such as migraine and anxiety.

Beta-blockers have been a standard treatment for heart conditions for decades, and are commonly recommended in countries such as the USA, Canada, Australia, and in Europe.

So when the researchers reviewed how much help the drugs were to patients, you would think they would see a significant benefit. Or – a fair benefit?

Surprising Results

The study concluded (as quoted by Forbes):

Among patients enrolled in the international REACH registry, beta-blocker use was not associated with a lower event rate of cardiovascular events at 44-month follow-up, even among patients with prior history of MI. Further research is warranted to identify subgroups that benefit from beta-blocker therapy and the optimal duration of beta-blocker therapy…

In other words, the beta-blockers did not seem to prevent further heart “events”, such as heart attack!

This was no small study. Data was analyzed from 44,000 patients. And the differences between those on beta-blockers and not on beta-blockers tended to be slight.

Take for example those coronary artery disease. 13.6% of those not on beta-blockers had a heart attack, stroke, or died from heart disease within 44 months. 12.9% of those on beta-blockers were the same. A difference of only 0.7%, and not statistically significant.

Among people just at high risk, 12% not on beta-blockers had a “bad outcome” within 44 months, and 14.2% on beta-blockers! That’s right, in this case there was a slightly higher risk for those actually taking the drug.

Another recent review of 8,912 people led to a similar result. The researchers led by Dr. Jim Wright of the University of British Columbia in Canada found that those with hypertension taking beta-blockers did not have a lower mortality rate than those not on the drug.

Doctors Cautious

Naturally, with a treatment as well-entrenched as beta-blockers, doctors are not quick to make a change. First of all, this study was simply an analysis of the available data, and couldn’t take into consideration other factors that may have impacted the outcome.

One of the most important variables that you might miss in the news is that beta-blockers are taken at different times for different things. Most are still suggesting that there’s more than enough evidence to continue to prescribe beta-blockers right after a heart attack, for example.

And patients are urged NOT to stop taking beta-blockers without talking to their doctor. They may have very good reason to take them.

On the other hand, many may not. And the cost of taking beta-blockers for months and years – when the side effects may be worse than the benefits – could be staggering.

Migraine Patients Need to Know

So what does this have to do with migraine patients? Well, migraineurs generally take beta-blockers for migraine symptoms as a preventative. We’re not sure how beta-blockers change the migraine chain-reaction, but we do know that for many people they reduce their attacks quite significantly.

Doctors are already cautious about prescribing beta-blockers to migraine patients who also have a heart condition. However, there are times when certain patients may take a beta-blocker for migraine and hypertension.

Migraine patients are also believed to be at higher risk for stroke and heart attack, which may lead some doctors to try beta-blockers before other treatments.

But this approach may need to be re-evaluated. For some, the side effects of beta-blockers (such as fatigue, dizziness and nocturna) may no longer be worth it. Others may want to look into medications that are more likely to help with their condition.

Now that generic versions of beta-blockers are available, there are likely to be fewer high-powered expensive studies done. Then again, maybe we’ll start seeing studies that are more objective.