One way to treat chronic migraine is with preventive medications, also called prophylactics. You take these medications regularly to help prevent migraine attacks, rather than after symptoms start.

Preventive migraine medications can help you have migraine attacks less often and may also make the ones you do get less severe. They’ve been shown to help people with migraine feel better and have a better quality of life. Beta-blockers are one form of preventive migraine medication. Here’s what you need to know about beta-blockers so you and your doctor can decide if they’re right for you.

What Are Beta-Blockers?

Beta-blockers are medications that are usually used to treat cardiovascular (heart and blood vessel) conditions, but can be used to help with several conditions throughout the body, including migraine. They block the effects of stress hormones like adrenaline, which can lower heart rate and blood pressure.

There are many beta-blockers available, but only some have been shown to help prevent chronic migraine. Propranolol (sold as Inderal LA, InnoPran XL), metoprolol (Lopressor), and timolol have the strongest evidence as preventive migraine medications. Atenolol and nadolol may also help, but there is less research on them. Other beta-blockers either have not helped prevent migraine in studies or have not been studied enough to know.

Different researchers have reached different conclusions about which beta-blockers may help prevent migraine. One review of several studies found the strongest evidence for propranolol. You and your doctor can decide which medication to try if you think beta-blockers are right for you.

How Beta-Blockers Help Migraine

Researchers don’t know exactly how beta-blockers help prevent migraine attacks or make them less severe. But these medications affect the body in several ways that may help.

Changes to the Stress Response

Some people have migraine attacks when their stress level changes, especially when it drops quickly. Others get migraine attacks when they’re stressed. Some also have let-down attacks, which happen when stress goes down suddenly.

Two brain chemicals called neurotransmitters help control the body’s stress response. These chemicals are epinephrine and norepinephrine. Beta-blockers change how these chemicals work in cells throughout the body. One idea is that this may help keep stress levels steadier, which could help prevent migraine attacks triggered by sudden changes in stress.

Blood Vessel Changes

Beta-blockers can relax blood vessels, which is one reason they are used to treat hypertension (high blood pressure). They may help prevent migraine by affecting blood vessels and other processes involved in migraine.

Shifts in Brain Activity

Beta-blockers also affect other brain activity that may play a role in migraine. One area they may affect is the hypothalamus, a part of the brain involved in regulating sleep, hormones, and stress. By changing activity in this area, beta-blockers may help reduce how often migraine attacks happen.

Beta-blockers also affect the brain’s electrical activity. They may help limit certain slow changes in brain activity that are linked to the early stages of a migraine attack. This may be one reason they help prevent migraines.

Differences in How the Body Feels Pain

Beta-blockers may also change how you feel pain. Some types of beta-blockers may also affect pain pathways. Certain chemical responses in your body tell your brain that you're experiencing pain. The more active, or excited, they are, the more pain you feel. The use of beta-blockers seems to prevent some of these chemical responses from getting too active, so they could change how intense migraine attacks feel.

The beta-blockers noted in the study above aren’t the ones usually used to treat migraine. It may be that other beta-blockers also affect pain pathways in the body, or that these medications should be studied in connection with migraine. Right now, though, there’s not a lot of evidence indicating that this is the way beta-blockers help with migraine attacks.

Strategy for Using Beta Blockers for Migraine

Before you consider using beta-blockers for migraine, it helps to know some key facts.

Beta-blockers might not help everyone with migraine in the same ways. If your migraine attacks are triggered by high blood pressure or changes in stress, these medications may be more likely to help. If you have other conditions treated with beta-blockers, like heart problems, tremors, anxiety, or an overactive thyroid, these medications may help with both those conditions and your migraine attacks.

It can take time for beta-blockers to reach their full effect. In fact, doctors say that you may need to take them for 12 weeks to know if they’re going to help you and how much. Some studies look at their effects after eight weeks and see changes, so you might not always have to wait quite so long. You and your healthcare provider can decide how long to try the medication before deciding if it helps.

Side Effects and Cautions for Using Beta-Blockers

Just like most medications, beta-blockers can have side effects. People may have different side effects, and they may vary in how strong they are. Look for:

• Feeling more tired than usual
• Slower heart rate
• Dizziness
• Cold hands and feet
• Upset stomach
• Dry mouth or dry eyes
• Sexual dysfunction
• Changes in sleep or dreams

Tell your doctor if you have side effects. They can help you decide whether to stay on the medication or make changes based on how severe the side effects are and how much they affect your daily life.

Some people shouldn’t take beta-blockers. For example, if you have asthma or COPD, your doctor may not want you to take them. Beta-blockers may also not be right for you if you have a very low resting heart rate or certain heart rhythm problems. People with certain allergies, kidney disease, liver disease, or some types of diabetes, and people over 60 should work with their doctors to make sure beta-blockers are safe for them.

Once you start a beta-blocker, don’t stop taking it without working with your doctor. Sometimes, stopping these medications too quickly can make things worse. You may need to come off the medication slowly, taking smaller and smaller doses over time, so your body can safely adjust to being without it.

Talk to Your Doctor

If you’re interested in starting a beta-blocker or another preventive medication for migraine, talk to your healthcare provider. They can help you choose a medication that may help prevent your migraine attacks.

You should also talk to a healthcare professional if you’re taking a beta-blocker and start having new or severe side effects, or if you develop a condition that may make it unsafe. You and your doctor can decide what’s best based on your overall health.

Join the Conversation

On MyMigraineTeam, people share their experiences with migraine, get advice, and find support from others who understand.

How have beta-blockers helped with your migraine attacks? Let others know in the comments below.