Beta-Blockers for Migraine

Medically Reviewed by Murtaza Cassoobhoy, MD on February 13, 2023
4 min read

A medication that is used to treat high blood pressure can lessen serious headaches for some people. These drugs are called beta-blockers.

Tell your doctor if your headaches or other migraine symptoms aren’t well-controlled. Fewer than half of people who need preventive medication get the treatment they need. There’s no cure, but there are lots of ways to manage migraine attacks. Your health care team can help you figure out if beta-blockers are right for you.

They’re drugs that block the effects of epinephrine, or adrenaline. That’s a hormone your body sends out when you’re stressed, scared, or excited. Beta-blockers relax blood vessels and slow your heart rate. That lessens how hard your heart has to work and makes it easier for your blood to flow.

There are different kinds of beta-blockers. None were originally designed to treat headaches. But two are approved for migraine:

  • Propranolol
  • Timolol

There’s less evidence to support the use of other beta-blockers for migraine. But your doctor might use certain ones “off-label” to treat your headaches, including:

  • Atenolol (Tenormin)
  • Metoprolol (Lopressor, Toprol XL)
  • Nadolol (Corgard)

These drugs won’t stop a migraine after it starts. Instead, they’re used to ward off future attacks. Your doctor may call that prophylaxis treatment. Scientists figured this out by accident in the late 1960s. 

It’s not clear how beta-blockers help with migraine. Experts think several things are going on. One theory is they block a process called cortical spreading depression. That’s a set of changes in the brain that may trigger a migraine.

Beta-blockers may also:

  • Control how blood vessels widen
  • Affect certain brain chemicals, mainly serotonin
  • Block pain signals
  • Calm your nervous system

Most scientific research shows that beta-blockers are a good way to treat episodic migraines -- fewer than four headaches a month. But your doctor may still want you to give them a try if you have chronic migraine. That’s when you have at least 15 headache days a month.

Your migraine management plan depends on several things. That includes how often you have headaches, how serious your symptoms are, and what kind of medicine you’ve tried in the past. Your overall quality of life matters, too.

Here are some questions your doctor may ask to decide if you need preventive treatment: 

  • Do migraine symptoms make it hard to go to work or socialize?
  • Do you have four or more headaches a month?
  • How often do you take  acute, or “rescue,” treatments?
  • Do your headaches last more than three days?

Your doctor might lean toward beta-blockers right off the bat if you have certain medical conditions, such as:

  • High blood pressure (hypertension)
  • Chest pain (angina)
  • Anxiety in certain situations (stage fright)
  • Fast heart rate (tachycardia) 

There’s lots of evidence to show that, when taken every day, beta-blockers are a good way to lessen future headaches by at least half. And if you do have a migraine attack, it may be shorter and less severe.

Your doctor may start you off on a short-acting dose that you take two times a day. If that goes well, they may switch you to one long-acting pill later on.

Drugs for migraine prevention, including beta-blockers, may not help right away. You’ll likely need to wait at least 8 weeks to see if there's any improvement. But tell your doctor sooner if you don’t feel any better. They may need to change your dose or add another migraine drug.

Be open about any of your lingering symptoms. Your doctor can give you medication for breakthrough headaches even if you’re on preventive treatment. Lifestyle changes or other therapies may also help.

Your doctor will go over all the pros and cons of your treatment choices. But they’re unlikely to prescribe beta-blockers if you have certain health conditions, including:

  • Asthma
  • Other lung problems
  • Heart rhythm problems like AV-block or sick sinus syndrome
  • Heart failure
  • Slow heart rate (bradycardia)

Other conditions that might make beta-blockers a no-go include:

  • Diabetes
  • Low blood pressure when you stand up
  • Raynaud disease

Tell your doctor if you have active depression. They’ll want to keep a close eye on how you feel after you start a beta-blocker. These drugs don’t usually cause mood issues, but you may feel a little down when you take them.

They’re generally considered safe. But like all drugs, they may cause some unwanted symptoms.

Common side effects include:

  • Cold hands or feet
  • Lightheadedness
  • Tiredness
  • Lower ability to exercise
  • Low blood pressure

Less common side effects include:

  • Trouble breathing
  • Stomach problems
  • Insomnia or nightmares
  • Swelling in your hands and feet
  • Sexual dysfunction

Bring up any symptoms that bother you. You may need to change your dose or switch to a different treatment.

There may come a time when you want to stop your medication. But you could have heart rate or blood pressure problems if you stop taking beta-blockers all of a sudden.

Always talk to your doctor before you make any changes to your treatment. They’ll help you stop or switch to another medication safely.