Beta blocker for acute migraine treatment?
Dr. Steven Kosa is a distinguished Neurologist in North Kansas City, MO. Dr. Kosa specializes in diagnosing, treating, and managing disorders of the brain and nervous system. With expertise in handling complex conditions like epilepsy, multiple sclerosis, and migraines, Dr. Kosa employs advanced techniques and personalized... more
I have recently worked with a local ophthalmologist in developing an acute migraine treatment option using a beta blocker (Timolol 0.5%) by nasal spray through a local compounding pharmacy. Beta blockers were first used to reduce the heart rate and blood pressure but it was found patients taking daily beta blockers had less migraines so the class of drugs has been used for many years for migraine prevention with success. Beta blocker tablets have not been beneficial for acute migraine prevention given a delay with GI absorption in achieving therapeutic blood levels. My ophthalmology colleague noted improvement in migraines in patients using beta blocker eye drops (Timolol) used to treat glaucoma seemed to provide not only preventive migraine relief but also some degree of acute benefit by the mechanism of absorption through the upper portion of the nose directly to the blood stream (via drainage to the nose through the nasolacrimal duct). This led to the off-label use of the drops sublingually and then by compounded nasal spray with significant benefit for acute migraine treatment and very minimal side effects. Given these early results, we worked with O'Brein Pharmacy to compound a 0.5% timolol nasal spray for patients to use acutely after being seen in the headache clinic. In general, two thirds of the patients responded favorably with only one complaining of mild nasal irritation as a side effect. The trial had limitations as it was small and unblinded without a placebo so clearly larger studies are needed and are currently in the works. The same general contraindications for the beta blockers class of medications apply. Currently the product can be obtained for a reasonable price through the mail with a provider's prescription from the following compounding pharmacies (with hopes of more being added as the word gets out).
O'Brein Pharmacy in Mission, Kansas https://obrienrx.com/
or
Bayview Pharmacy in Warwick, RI https://www.bayviewrx.com/
