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    Topical beta blocker for migraine treatment?

    Superior cost, convenience, tolerability, and overall safety profile of topical beta blocker compared with other migraine therapies

    The Neuro-Connection

    Although a few prior anecdotal case reports have described successful topical beta blocker use for migraine, a recent larger series of 7 patients was published by Migliazzo and Hagan in the August 2014 issue of Missouri Medicine. In this report, an initial patient reported improvement of her migraine headache pain after topical beta blocker use for glaucoma. Seven similar patients were then described all of whom reported improved headache within minutes after topical treatment. Included patients completed questionnaire data and their case histories were described in more detail by the authors. The authors emphasized the superior cost, convenience, tolerability, and overall safety profile of topical beta blocker compared with other migraine therapies.

    Andrew G Lee MDDr. LeeCompanion editorials appeared in the same issue of the journal discussing the strengths and weaknesses of the report. Oral beta blockers have long been used for prophylaxis of migraine but have not been shown to be effective for acute abortive treatment in migraine. Dexter and Cady noted several weaknesses in the methodology of the study including: 1) small sample size; 2) an unknown non-participation rate for the questionnaires; 3) an older aged cohort (> 60 years) compared with a typically younger migraine population; and 4) the concomitant use of other migraine treatments.

    Chung described the multiple potential mechanisms for beta blocker action in migraine including vasodilation, inhibition of sodium release, reduction or neuronal firing in the locus ceruleus, serotonin modulation, thalamic nuclei activation, and reduction of cortical spreading depression and highlighted some of the same limitations of the paper.

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