By Ryan J. Cady, MS; J. Kent Dexter, MD; Roger K. Cady, MD of The Headache Care Center in Springfield, Missouri In the annals of migraine, one of the most fascinating stories is how, in 1966, a physician named Robert Rabkin observed that the drug propranolol could prevent migraine. Dr. Rabkin was actually conducting a study using a beta-blocker (propranolol) to treat heart pain (angina) and fortuitously observed that one of his research subjects had a remarkable reduction in the frequency of his migraine attacks. A decade later, Drs. Seymour Diamond and John Graham presented their experience treating 86 migraine patients with daily propranolol to the Food and Drug Administration (FDA), and demonstrated that propranolol was indeed efficacious and safe for migraine prophylactic therapy. Subsequently, propranolol became the first FDA-approved medication for the prevention of migraine.

Two Kansas City ophthalmologists report on an inexpensive, effective way to treat migraine: widely available beta blocker eye drops, usually used to treat glaucoma. In the course of their research, Carl V. Migliazzo, MD, and John C. Hagan, III, MD, worked with 7 female patients who used the eye drops at the first sign of migraine symptoms. The subjects used this treatment over a multi-year period, and the patients reported nearly complete pain relief with the drops and few side effects.

The first controlled study to assess the combination of preventive drugs and behavioral techniques for hard-to-treat migraines found that using the techniques together leads to better outcomes. The study enrolled 232 people with frequent headaches that weren't controlled by acute medicines. They were randomly assigned to receive preventive medications (a beta blocker), behavioral management, both or neither. After 16 months of follow up, the combined approach offered significant improvement in number of attacks, headache days and quality of life, compared to modest improvement in those who used only one of the techniques.

Toprol XL is a beta blocker which is sometimes effective in the prevention of migraine. It is a cardio-selective beta blocker which can be used for some patients who have co-existing asthma. This compound like other beta blockers is devoid of instrinsic sympathomimetic activity, and...

Lopressor® is a beta blocker which is sometimes effective in the prevention of migraine. It is a cardio-selective beta blocker which can be used for some patients who have co-existing asthma. This compound is like other beta blockers devoid of instrinsic sympathomimetic activity that have...

Atenolol is a selective beta blocker FDA-approved to treat hypertension; it is not approved for prevention of migraine. However, clinical trials suggest that it may be useful in the prevention of migraine. Occasionally this medicine may produce marked reduction in pulse rate and blood pressure, leading...