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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

    Take-home message: A small case series of patients has shown that use of beta-blocker drops may be a simple and inexpensive way to eliminate pain in patients with acute migraines.

     

    Kansas City, MO :: Millions of patients suffer from migraines and their physicians historically have gone through herculean efforts to find pain relief, but interestingly an inexpensive and effective drug may literally be sitting on the shelf and waiting to be tested in clinical trials.

    Beta-blocker eye drops, used to treat glaucoma, have been shown in a series of patients to provide almost complete pain relief from acute migraine over years of use at very low cost to the patients.

    Carl Migliazzo, MD, an ophthalmologist in private practice in Kansas City, MO, has been focused on investigations into the usefulness of this therapy for acute migraines for decades. John C. Hagan III, MD, who is also in private practice in Kansas City, recently joined Dr. Migliazzo in this effort.

    Both investigators noted that while daily oral beta-blockers, such as timolol, betaxolol, levobunolol, metipranolol, and carteolol, have been used routinely to prevent chronic migraines, the drugs do not stop acute onset migraines after the onset of symptoms.

    Its mechanism

    The mechanism of action of the drops, the authors believe, is the passage of the beta-blockers into the nasal cavity and their rapid absorption into the blood vessels.

    “Within a few minutes, the blood level of the beta-blocker is increased sufficiently to stop the escalating migraine headache," Dr. Hagan said. "This action would explain the success of the beta-blocking eye drops and the failure of the oral medications, as delivery through the eyes is much quicker than through the gastrointestinal system.”

    In some of their most recent work published in the July/August 2014 issue of Missouri Medicine, the investigators evaluated the effects of timolol 0.25% and 0.5% and levobunolol 0.5% in seven women who used the eye drops when they first experienced migraine symptoms. According to Dr. Hagan, the women used these treatments over years, and the patients reported nearly complete pain relief and few adverse effects.

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