beta blocker in migraine

Last edited 05/2021 and last reviewed 05/2021

Although the usual recommended dose of propranolol is 40 mg bd, 10 mg tds may be sufficient for migraine prophylaxis.

Beta-blockers are the treatment of choice in patients whose migraine attacks are related to stress.

Migraine with or without aura (2)

  • topiramate or propranol are the suggested first line prophylactic agents
    • for the prophylaxis of migraine, offer topiramate or propranolol after a full discussion of the benefits and risks of each option. Include in the discussion:
      • the potential benefit in reducing migraine recurrence and severity
      • the risk of fetal malformations with topiramate
      • the risk of reduced effectiveness of hormonal contraceptives with topiramate
      • the importance of effective contraception for women and girls of childbearing potential who are taking topiramate (for example, by using medroxyprogesterone acetate depot injection, an intrauterine method or combined hormonal contraception with a barrier method)
    • Follow the MHRA safety advice on antiepileptic drugs in pregnancy
    • In November 2015, this was an off-label use of topiramate in children and young people
    • People with depression and migraine could be at an increased risk of using propranolol for self-harm. Use caution when prescribing propranolol, in line with the Healthcare Safety Investigation Branch's report on the under-recognised risk of harm from propranolol