Migraine headaches and beta blockers??

[doc3341]

I was just wondering if any of you knew how effective the beta blocker PROPRANOLOL(Inderal) is in preventing headaches??? Its supposed to be effective in preventing them at least thats what Ive read. Also, what are the side effects that you have seen in patients who take this drug?? Ive heard that they can be as mild as dizziness to as sever as impotence!!! Please help I suffer from frequent migraines, at least one a week, and wanted to bring this option up to my neurolgist. thanks in advance!

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[neurologist]

Beta blockers (particularly propranolol) are frequently used for migraine prevention. The actual mechanism of action is not particularly well understood, but they do seem to reduce the overall frequency and severity of migraines. Keep in mind that they will NOT by any means eliminate your headaches; a 50% reduction in headaches with any prophylactic medication is a great result. Any preventive medication must be taken daily, whether you have a headache or not, in order to be effective. Most require several weeks or even months, and possible escalating doses, before any effect is noted.

Common side effects of propranolol are, as you noted, lightheadedness/dizziness from the antihypertensive and bradycardic effects of the medication. In patients who are very active, a degree of exercise intolerance may be noted for the same reason. Impotence can occur in men and depression is also reported, although I've seen some studies that seem to indicate that this is really quite rare. I have seen all these side effects from propranolol.

Other commonly used migraine preventives are verapamil (a calcium channel blocking antihypertensive), the antiepileptic medications valproate and topiramate, and tricyclic antidepressants (amitriptyline and nortriptyline). Any neurologist you go to will know all about all of these. Choice of medication is mostly based on patient tolerance, comorbidities and other meds (i.e., if you're a woman on oral contraceptives, topiramate would probably not be your first choice . . . oops).

 

[doc3341]

thanks for the reply, Im currently taking Mobic, a NSAID, and my Neurologist told me it was similar to Vioxx. Im taking Mobic b/c my insurance doesnt cover vioxx, but he said the results would be similar. I read a couple of studies in patients taking Vioxx for 12 weeks, reporting a 50 % reduction in migrain headache frequency. Unfortunateyl i havent had that great of a result with the Mobic, so Im hoping hell put me on vioxx, and ill just fork over the $$ and hope it works before he puts me on a beta or calcium chanell blocker. What do you think??? Thanks for the reply.

 

[neurologist]

I'm not surprised the Mobic isn't doing much for you. I have the same situation in my practice (i.e., insurance and/or formulary won't allow Vioxx or other Cox2), so I've tried Mobic as an alternative in a couple of patients: it never seems to work. Vioxx has recently gotten an FDA indication for migraine. It's worth a try if you can get it.

You didn't mention it in your post, but have you been on a triptan (Imitrex, Zomig, Relpax etc)? Not sure what your insurance allows, since they are pricey, but also pretty effective headache abortives. As for prophylactic meds, if you are getting more than one bad migraine a week that isn't responding well to symptomatic treatment, you shoud probably be on a preventive med. Which one is up to you and your doc and maybe your HMO.

Keep in mind that headache treatment, no matter how scientific, ultimately comes down to a lot of trial and error, since often what works for one person won't do anything for the next patient. You may have to burn through several med trials before finding what works for you.

 

[doc3341]

Actually my neurologist did give me some samples of Zomig and Relpax, and they both work really well. My problam basically started like 8 weeks ago. I have always suffered from headaches, at least the last 6 years or so. Anyway about 8 weeks ago I started having these blinding one sided headaches, right over my left eye and temple. For the next four weeks, I was defientely overusing/abusing just about every over the counter pain med out there. Advil, Aleve, Excedrin. All of which only gave me temporary relief and the headaches alwys came back. I was having about two really bad ones a week. The bigger problem was that I constantly had a a ull achy pain over my left eye and temple, and I really never knew when it was going to get bad. So thats when I saw my doc, got rteferred to a neurologist, and he put me on Dexamethasone for 4 days(16mg, 12mg, 8 mg, 4 mg) and them mobic . He told me to take 7.5 mg 2 times a day of the mobic. The good news is that in the last two weeks, Ive only had 3 migraines. I think this happened because every time I had the migraines I had been tryting to take the mobic just once a day and after about 2 days of mobic just oince a day Id get a headache. Ive learned my lesson and am now taking it 2 times a day. AS for the dull constant pain over my left eye and temple, well its still there, but the intensity and duration of the pain throughout the day is much less. Instead of having it for 4 or 5 hours at a time, Im having that oaind for like an hour at a time. This being said, how safe is the use of mobic, or vioxx for that matter as a prophalactic med??? How long should I be on this stuff?? Thanks again

MIKE

 

[kingyogurt]

doc3341,
Hey if you dont get any relief from your headaches you should look into the Diamond Headache Clinic in Chicago. I am a fourth year medical student doing a 2 week rotation there and was amazed at the great results and noticed a lot of patients came from all around the world to get help there. Im not trying to sell them or anything because im just a medical student but i thought u would like to know

 

[doc3341]

doc3341,
Hey if you dont get any relief from your headaches you should look into the Diamond Headache Clinic in Chicago. I am a fourth year medical student doing a 2 week rotation there and was amazed at the great results and noticed a lot of patients came from all around the world to get help there. Im not trying to sell them or anything because im just a medical student but i thought u would like to know

Ill defientely keep that in mind if things dont improve. Thanks for the Heads Up!!

 

[neurologist]

how safe is the use of mobic, or vioxx for that matter as a prophalactic med??? How long should I be on this stuff?? Thanks again

MIKE

Remember that plenty of people are on Vioxx and Mobic practically forever for their arthritis, so it's pretty safe. However, keep in mind that being on a prophylactic for headache is not necessarily a lifetime thing. If your prophy med kicks in and you can get 3-6 months of reasonably good headache control, you can think about tapering it off.

 

[doc3341]

Remember that plenty of people are on Vioxx and Mobic practically forever for their arthritis, so it's pretty safe. However, keep in mind that being on a prophylactic for headache is not necessarily a lifetime thing. If your prophy med kicks in and you can get 3-6 months of reasonably good headache control, you can think about tapering it off.

Ohh now I see how that works.Does that same Proph approach apply to the Beta Blockers and Anti-Epileptic drugs as well?? The Mobic really isnt working too well (Ive had 4 migraines in about 17 days) , and I just found out that my Insurance doesnt cover Mobic or Vioxx! I was taking "professional Samples" for 2 weeks. So Im gonna call my Neurologist tomorrow and see if he can write me script for vioxx b/c Im almost out of the mobic. Just out of curiosity, why is it that Vioxx tends to work better than Mobic?? I saw a couple of articles touting vioxx as a good treatment and preventive med for migraines and was hoping you could clarify?? Also, whats a good dose if Im gonna be taking vioxx prophalactically?? I was on Mobi as posted earlier 7.5 mg BID., ??? Thanbks again!!!

http://www.diamondheadache.com/article_archives/advancements.html


http://my.webmd.com/content/article/33/1728_82656.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348}



-Mike