Ryan J. Cady, MS, J. Kent Dexter, MD, Roger K. Cady, MD The Headache Care Center, Springfield, MO
In the annals of migraine, one of the more fascinating stories is how, in 1966, a physician named Robert Rabkin observed that the drug propranolol could prevent migraine. Dr. Rabkin was actually conducting a study using a beta-blocker( propranolol) to treat heart pain( angina) and fortuitously observed that one of his research subjects had a remarkable reduction in the frequency of his migraine attacks. A decade later, Drs. Seymour Diamond and John Graham presented their experience treating 86 migraine patients with daily propranolol to the Food and Drug Administration( FDA), and demonstrated that propranolol was indeed efficacious and safe for migraine prophylactic therapy. Subsequently, propranolol became the first FDA-approved medication for the prevention of migraine.
As one of many beta blockers used commonly to prevent migraine, propranolol currently, is probably the mostly widely prescribed medication in the world for prevention
of migraine. Beta blockers are used to treat multiple diseases including high blood pressure, heart pain, and irregularities of the heart as well as conditions such as anxiety and certain types of tremors. Beta blockers have been so successful that they are considered one of the most important medical discoveries of the 20 th century.
In 1978, a second beta blocker, timolol, also received FDA approval as the first topical beta blocker for the treatment of glaucoma. Although clinical trials demonstrated a very strong benefit from using timolol as a migraine preventive, neither it nor propranolol have demonstrated efficacy as an acute treatment for migraine. However, these previous studies have focused on oral preparations of these drugs and the drug was not absorbed quickly enough to be effective as an acute treatment. Interestingly, since the 1980s, there have been rare case reports of patients with glaucoma being treated with timolol eye drops who experienced migraine relief.
16 HeadWise ® | Volume 5, Issue 1 • 2015