By John C. Hagan, III, MD
Inexpensive, widely available beta blocker eye drops, usually used to treat glaucoma, may stop acute migraine headaches in their tracks. So reports the July-August 2014 issue of the respected peer-reviewed medical journal Missouri Medicine. Migraine headaches develop in about 16% of women and 5% of men and are a common problem in emergency rooms and doctors’ offices. Migraine headaches may last hours to days and are a frequent cause of job and school absences.
Kansas City-based ophthalmologists Carl V. Migliazzo, MD and John C. Hagan, III, MD report findings from a small series of case studies of female patients who put beta blocker eye drops onto their eyes at the earliest onset of migraine symptoms. The seven case study patients used the drops to successfully stop their migraines over multi-year periods. Regular daily oral beta blocker pills are used routinely for chronic migraine prevention. However oral beta blocker pills do not stop acute onset migraines when taken intermittently after symptoms—such as flashing lights (aura), headache, light and sound sensitivity—begin. Until this study was reported, there was no satisfactory explanation for this paradox.
The study’s authors postulate that, when taken intermittently as pills for a sudden migraine attack, beta blocker medication is absorbed too slowly by the gastrointestinal system to work. However, when taken daily, beta blocker pills build up in the blood to the level necessary to prevent migraines in many people. In eye drop form, the beta blocker rapidly passes by way of the tear ducts into the nasal cavity where it is quickly absorbed into the extensive system of blood vessels located there. Within a few minutes the blood level of beta blocker is high enough to stop the escalating migraine headache. This would explain the success of eye drops, and the failure of pills, to stop an acute migraine.
Not all migraine patients are candidates for beta blocker eye drop therapy. Those cautioned against using it include individuals with asthma and other breathing problems. Certain eye problems can also preclude their use. Beta blocker eye drops for acute migraines should not be used except under the direction of physicians familiar with their use.
Beta blocker eye drops are inexpensive, available worldwide, and absorbed rapidly. In an accompanying editorial, migraine headache specialists describe the therapy as promising and call for larger, placebo-controlled prospective studies. If beta blocker eye drops do indeed prove to be effective against acute migraine symptoms, it would be a welcome addition to migraine therapy.
John C. Hagan, III, MD, MSMA member since 1977, is a Kansas City ophthalmologist.
Published August 25, 2014
Editor's note: This article is part of a special series brought to you by Missouri Medicine, the Medical Journal of the Missouri State Medical Association (MSMA). MedHelp, Missouri Medicine, and MSMA are collaborating to educate and empower health consumers by making the latest scientific studies and medical research available to the public. Learn more about MSMA and see more from Missouri Medicine.
This is a summary of the article “Beta Blocker Eye Drops For Treatment of Acute Migraine: Case Presentations and Review” by Carl V. Migliazzo, MD & John C. Hagan III, MD, which was originally published in the July/August 2014 issue of Missouri Medicine. The full article is available here.