Propranolol for Migraine Prevention

Propranolol is one of the more effective medicines used for repeated migraines. Also known by the brand names Inderal LA and InnoPran XL, it has been found to be more likely to reduce this type of headache by half compared to other medications. Therapeutic benefits can be seen as early as four weeks of use.

Propranolol falls under a broad category of drugs called oral migraine prevention medications (OMPMs). These drugs were developed to treat other conditions but were subsequently found to be helpful for migraines.

This article looks at propranolol for migraines, how it works, how it's taken, and the potential side effects and warnings associated with propranolol.

How Does Propranolol Work for Migraines?

Propranolol is in the class of drugs called beta-blockers. It's usually used to treat cardiac conditions, such as:

• High blood pressure
• Heart rate irregularity
• Stable angina/unstable angina

It's also prescribed to treat a certain type of tumor of the adrenal gland, a small gland above the kidneys.

The way propranolol helps prevent migraines is still not well-known. Several theories exist.

• It may help stabilize the blood vessels in the brain, preventing their dilation (widening), which is associated with headaches.
• It may also reduce the excitability of the brain and lessen anxiety, which may help decrease the frequency of migraines.
• It stabilizes levels of the brain chemical serotonin. Fluctuating serotonin levels are associated with migraines.
• It reverses the effects of adrenaline, which constricts blood vessels surrounding the brain and may contribute to migraines.

How Much Propranolol Should I Take for Migraines?

Propranolol is available as an immediate-release tablet or an extended-release capsule. The immediate release tablet should be taken on an empty stomach.

The extended-release capsule can be taken with or without food—but you must be consistent: decide whether to take it with or without food and then stick to that.

Studies have looked at different doses of propranolol. In one, participants took 80 mg per day. Other reports suggest doses between 40 mg and 160 mg daily.

For migraine prevention, doctors usually prescribe:

• 20 mg of propranolol
• Three to four times a day to start
• If necessary, the dose is gradually increased to between 160 mg and 240 mg per day

If the drug works for you, the frequency of your migraines may be reduced by half or more. They should also be shorter and less intense.

It takes between four to six weeks for propranolol to start working. Many consider this delay to be a downside of the drug and understandably become frustrated with the long wait time.

A Word From Verywell

Having patience is key when it comes to propranolol, both because it can take several weeks to be effective and also because it should not be abruptly stopped after being used for an extended period of time. Discussing a taper schedule with your healthcare provider is important.

— NICHOLAS R. METRUS, MD, MEDICAL EXPERT BOARD

Potential Side Effects of Propranolol

Propranolol is usually very well tolerated, but side effects are possible. Some of the more common include:

• Fatigue
• Weight gain
• Dizziness
• Constipation
• Sleep problems
• Stomach cramps
  

As with any medication, discuss potential side effects with your doctor before you start taking this drug.

Propranolol Drug Interactions

Some substances may interfere with propranolol. For this reason, it's important to tell your doctor about all the medications you're taking, including:

• Prescription medications
• Over-the-counter medications
• Vitamins and supplements
• Herbal products

For example, propranolol significantly increases the levels of some common migraine medications by up to 70%. These drugs include:

• Zomig (zolmitriptan)
• Maxalt (rizatriptan)

If you're taking propranolol and Maxalt, your healthcare provider may lower your Maxalt dosage. (Don't lower it without talking to your provider.)

Who Shouldn't Take Propranolol for Migraines?

Propranolol isn't safe for everyone.

No controlled studies have looked into the use and safety of propranolol during pregnancy. You should only take this drug if the potential benefit outweighs the potential risk to the baby.

Propranolol is released into breastmilk, so be sure to tell your healthcare provider if you're breastfeeding.

Propranolol is unsafe for people with certain health conditions, including:

• Cardiogenic shock or severe heart failure
• Second or third-degree heart block
• An allergy to propranolol

What Are the Warnings for Propranolol?

Take propranolol only as prescribed. Stopping it suddenly may cause a heart attack. To avoid this, slowly reduce your dosage of propranolol over at least a few weeks under the guidance of your healthcare provider.

Propranolol may mask the signs of:

• Thyrotoxicosis/overactive thyroid gland
• Low blood sugar (hypoglycemia), especially in people with insulin-dependent diabetes

Certain other conditions may exclude you from being able to take propranolol, or require that you take it while closely monitored. These include:

• A baseline low heart rate or blood pressure
• Asthma
• Depression
• Peripheral vascular (blood vessel) disease

Propranolol is considered a well-tolerated and generally safe drug. Still, there are other serious warnings associated with taking it. Be sure to review these in detail with your healthcare provider to ensure it's the right drug for you.

Other Migraine Treatment Options

If propranolol is not right for you, you have other options for migraine prevention. These include:

• Other beta-blockers
• The anti-seizure medication Topamax (topiramate)
• Botox (botulinum toxin type A)
• An injectable drug called Aimovig (erenumab)
  

Summary

Propranolol is a beta-blocker drug that is sometimes prescribed for the prevention of migraines. It may work by preventing the dilation of blood vessels and stabilizing serotonin levels.

If propranolol works for you, your migraine attacks will be shorter, less intense, and less frequent. It may take up to six weeks before you'll notice this effect.

Propranolol may cause side effects and may interact with other medicines. Make sure to discuss the benefits and drawbacks with your doctor before you start taking this drug.