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Propranolol in migraine prophylaxis


Clinical bottom line

Propranolol reduces migraine activity when used prophylactically. On the basis of this review, it is not possible to gauge the size of this reduction.

Beta-blockers are competitive antagonists of adrenaline and noradrenaline at beta-adrenoceptors. Propranolol is the most commonly used of the beta-blockers, although timolol, metoprolol and nadolol are also used in migraine prophylaxis. However, there are a number of important side-effects associated with this class of drugs.

Systematic review

Holroyd KA, Penzien DB, Cordingley GE. Propranolol in the management of recurrent migraine: a meta-analytic review. Headache. 1991; 31: 333-340

  • Date review completed: pre April 1991
  • Number of trials included: fewer than 53
  • Number of patients: not stated
  • Control group: placebo
  • Main outcomes: Headache index (composite score of frequency, duration and intensity); percent improvement on headache index.
Inclusion criteria were adult patients with recurrent migraine; group size of 5 or more. Reviewers looked at propranolol vs. pretreatment baseline and propranolol vs. placebo. Only the placebo comparisons are considered here. Methodological weaknesses: reviewers may have included non-randomised and non-blinded trials in their review; reviewers did not attempt to analysed different propranolol doses separately.


When compared with placebo, propranolol was associated with a 34% improvement in patient migraine activity. This percent was derived from weighted trial scores. However, this should be treated with caution given the methodological weaknesses listed above. Reviewers state that most trials looked at propranolol use over a six month period. One trial continued for eight to 16 months, and reported good maintenance. This trial also reported improved migraine ratings when patients were switched to placebo. Comparative figures were not given.

Adverse effects

Not covered by this review

Further reading

A non-systematic review of beta-blockers may be useful to some people.

Tfelt-Hansen P. Efficacy of beta blockers in migraine. A critical review. Cephalalgia. 1986; 6 Supp(5): 15-24.

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