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    Acute migraine sufferers may find relief with beta-blocker eye drops

    Case building for this promising, yet unexplored therapy with push for clinical trial

     

    Case reports

    Two representative cases showed the effectiveness of the beta-blocker therapy for acute migraines.

    A 38-year-old woman had had migraines for 25 years. Her acute episodes were characterized by right-sided headache, nausea, vomiting, light and sound sensitivity, and confusion. Untreated migrainous episodes lasted 24 hours or longer. Relief sought with several oral treatments brought symptom relief after several hours.

    She began instilling one drop of topical timolol 0.25% ophthalmic solution bilaterally with the first migraine symptoms with symptom relief after 10 to 20 minutes. On a scale of 1 to 10, the patient rated her relief as 8. She reported slight shortness of breath with bilateral instillation and now uses one drop in one eye with no adverse effects.

    A 57-year-old woman, who began having migraines at age 5, complained of visual aura, unilateral headache, nausea, vomiting, photophobia, and confusion as her typical symptoms. Her migrainous episodes began with visual aura lasting 10 to 20 minutes following by severe pain above the right eye. The migraines usually lasted 4 to 6 hours following by a feeling of a hangover for one to two days.

    About 27 years ago, she started using timolol 0.5% ophthalmic solution sublingually when the aura began. Improvement began in about 10 minutes and in 30 to 45 minutes the symptoms were completely relieved.

    She also had asthma, but use of timolol did not cause breathing problems. In her mid to late 40s, she was able to discontinue use of timolol when the migraines stopped.

    The investigator noted that not all patients with migraines are candidates for this treatment if they have asthma, other breathing problems, and some eye problems. The authors also stressed that these patients taking beta-blocker eye drops for acute migraine attacks be monitored closely.

    Dr. Hagan noted that while this study had only seven patients, if the results could be replicated in larger placebo-controlled studies, this treatment approach could be beneficial worldwide.

    Roadblocks

    Dr. Hagan emphasized that beta-blockers have been reported to successfully eliminate the pain of migraine over the last 35 years. The first reports appeared in 1980 and were followed by others, but to date, no large clinical trials have been conducted. Dr. Hagan blames this on the fact that the drugs are available generically, which will provide little profit for the pharmaceutical industry to explore this treatment.

    He emphasized that prospective, masked, controlled, randomized, clinical trials are long overdue and they could prove or disprove whether beta-blocker drops are useful for treating acute, even chronic migraines.

    Dr. Migliazzo and Dr. Hagan are currently working with a private headache center to obtain grant money in order to carry out a prospective trial of the beta blockers in patients with acute migraine.

     

    Carl Migliazzo, MD

    E: [email protected]

     

    John C. Hagan III, MD

    E: [email protected]

    Neither doctor has a financial interest in any aspect of this report.

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