women with headache migraine

Propranolol for Migraine Prevention: A Complete Guide

Those who struggle with migraines understand that they can be absolutely debilitating and have a huge negative impact on your day to day quality of life. While many people have infrequent bouts with migraines, some have to endure long term migraines that can last for days and come on without warning or apparent cause. While there are multiple medication types used to treat and prevent migraines, beta blockers are a common choice due to their ability to prevent migraines from occurring in the first place with a relatively benign side effect profile.

What is Propranolol?

Propranolol is a beta blocker that is non-selective that has been used for decades (first discovered in 1962) to treat high blood pressure, chest pain, migraine headaches, essential tremors, and other symptoms. Propranolol binds to the beta receptors in your body and blunts the effect of hormones like adrenaline and can lower heart rate and blood pressure. Propranolol is some of the oldest and most widely prescribed beta blockers in the United States today with more than 17 million active prescriptions in 2017. Propranolol is FDA approved to take preventatively to prevent the onset of migraine headaches, however it’s effectiveness at treating an active headache is inconclusive and there are more effective OTC and prescription options for short term acute headache relief.

While propranolol was originally designed to treat other conditions and only later was found to be effective at preventing headaches, the American Academy of Neurology rates propranolol as a “level A” drug for migraine prevention and it is used frequently today for this purpose.

What are Migraine Headaches?

Migraine headaches usually include a series of multiple symptoms including pain on one side or both sides of the head, pulsing or throbbing pain, increased sensitivity to stimulus, and possibly nausea and vomiting.

Migraines tend to follow a four stage process form onset to recovery.

The 4 Stages of a Migraine Headache

1. Prodrome

The prodrome stage can occur multiple days before the onset of an acute migraine attack. Symptoms at this stage are usually mild and subtle and can include:

  • Increased food cravings
  • Changes in Stool
  • Neck Pain or Stiffness
  • Increased Thirst and Frequent Urination

2. Aura

The second stage of a migraine that is sometimes referred to as the “aura” stage can occur during or before a migraine attack for many people. The aura stage includes visual symptoms and disturbances of the nervous system. If recognized and and treat early, full migraine attacks can be prevented at this stage. On average this stage can last between 20 and 60 minutes.

Examples of symptoms experienced during the migraine aura phase include:

  • Visual irregularities, such as seeing strange shapes, bright spots, or flashes of light
  • Loss of vision
  • Losing feeling or numbness in face or body
  • Trouble with basic speech
  • Hearing sounds and unidentifiable noises
  • Unrestrained jerky movements

3. Attack

If left untreated, the migraine attack phase can last from four to seventy two hours depending on the individual and severity of the case.

While a migraine attack is occurring, you will experienece:

  • Intense pain in one or both sides of the head
  • Throbbing or pulsating head pain
  • Sensitivity to lights and loud sounds
  • Nausea and vomiting possible

4. Post-drome

The final stage which includes the end of the migraine attack as well as the aftermath is called the post-drone stage.

When a migraine attack ends, it is likely you will feel exhausted, drained, or confused for 12 – 48 hrs while your body recovers. Limit sudden head movements during this time to reduce pain.

Triggers That Can Cause Migraines

Although sometimes migraines can come on without notice and their root causes are still largely unknown, there are numerous triggers that the medical community has noticed can trigger migraines in some individuals. Some of these trigger include:

  • Large hormonal shifts or changes (especially in women during mensural periods, pregnancy, or menopause)
  • Alcoholic and highly caffeinated drinks
  • Stress or overwhelm (using brought on by work, school, or problems at home)
  • Overstimulation of senses – loud noises, strong odors, ect.
  • Jetlag or significant changes to your sleep schedule
  • Overexertion or too much strenuous activity
  • Changes in weather and climate
  • Drug use or various medications
  • Certain foods (aged cheeses, salty, or high processed food especially)
  • Food preservatives and additives

Migraine Causes and Risk Factors

While the medical community is currently not entirely sure on the exact mechanism that causes migraines, many hypothesize that imbalances in brain chemicals can play a significant role. Additional risk factors that make you more likely to experience migraines include:

Family History

migraines tend to run in families.


Migraines tend to peak in a person’s 30’s and then gradually lessen with age from there.


Women seem to be much more susceptible to experiencing migraines.

Hormonal changes

Menstruation and other hormonal changes can put people at much higher risk of migraine attacks.

How Does Propranolol & Other Beta Blockers Work for Migraines?

While the medical community is still working to understand more about migraines and how exactly propranolol and other beta blockers can prevent them. The most commonly accepted theory currently is that by relaxing the body’s body vessels and altering the flow to the brain, beta blockers can improve blood flow to your brain and thus reduce the risk of developing a migraine headache.

What Dose of Propranolol is Prescribed to Help with Migraines

Typically doctors will prescribe a dose of 20mg – 40mg taken 2 or 3 times a day for the prevention of migraine formation. In some cases doctors will prescribe an even higher dose, so it’s important to talk to a physician about your specific situation.

Can Propranolol Treat Active Headaches

While propranolol can be an effective tool to prevent migraine attacks from coming on, there is little support to show they are effective at reducing immediate symptoms of acute headaches in the short term. There are better options to consider to treat actively occurring migraines, propranolol should be used preventively rather than as a reactionary measure when you notice a migraine coming on.

Propranolol Side Effects & Risks

While propranolol can be an effective option for the prevention of migraine headaches, it is a serious prescription drug that does come with risk of side effects and it is not the right choice for everyone.

Common side effects that can occur from propranolol include:

  • Slowed heart rate
  • Hair loss
  • Dry eyes
  • Nausea
  • Weakness or fatigue
  • Breathing problems
  • Changes in blood pressure
  • Vomiting
  • Depression
  • Impotence

More serious side effects can occur when taking propranolol. If you experience any of the following side effects after taking propranolol contact your doctor as soon as possible for assistance:

  • Significantly Reduced Heart Rate
  • Low Blood Sugar
  • Cold hands or feet
  • Rapid weight gain or fluid retention
  • Severe nausea, diarrhea, or vomiting
  • Shortness of breath
  • Visual Hallucinations
  • Dizziness, light-headedness, or loss of consciousness

Those with the following preexisting conditions shouldn’t take propranolol for migraines:

  • Asthma, bronchospasm, or other problems related to breathing
  • Cardiogenic shock
  • Slower than normal heart rate
  • Raynaud’s syndrome or other peripheral artery diseases
  • Diabetes
  • Abnormal blood pressure levels

In addition, pregnant women and others should not take propranolol. As always, this is not a substitute for medical advice. Also speak with a doctor before trying any new drug, supplement, or exercise program.

Propranolol vs Metoprolol vs Timolol for Migraines

While propranolol is one of the oldest and most commonly prescribed beta blockers for migraine prevention, other beta blockers are sometimes used instead. Two other beta blockers used to prevent migraines are timolol and metoprolol. While all these belong to the same drug class, the main difference between them is the way they bind to beta receptors in your body and whether or not they cross the blood brain barrier.

Conclusion: Great for Migraine Prevention, Not The Best Option for Acute Short Term Pain Relief

Although not originally discover for this purpose, propranolol helps many people prevent the onset of migraine headaches and reduce the severity and duration of headaches. It is not a great choice to take if you are actively experiencing a migraine and are looking for immediate relief. If you struggle with regularly occurring migraines you can talk to your doctor to see if propranolol is an appropriate preventative treatment for your situation. If you would prefer an online consultation, Propranolol.com can connect you with a U.S licensed physician who can prescribe and have propranolol shipped directly to your home if appropriate.

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