From the Guidelines
The recommended dose of beta blockers for migraine prophylaxis is propranolol, 80 to 240 mg/d, as it has consistently shown efficacy in preventing migraine attacks. The dose of beta blockers for migraine prophylaxis varies by medication, but the most effective one is propranolol, with a dose range of 80 to 240 mg/d 1. Other beta blockers like timolol, atenolol, metoprolol, and nadolol have also been studied, but the evidence for their efficacy is limited compared to propranolol 1. Key points to consider when prescribing beta blockers for migraine prophylaxis include:
- Starting at the lower end of the dose range and gradually increasing over 2-4 weeks as tolerated
- It may take 4-8 weeks to see full benefit
- Continuing treatment for at least 3-6 months before assessing effectiveness
- Monitoring for side effects like fatigue, dizziness, and bradycardia
- Avoiding abrupt discontinuation
- Contraindications in patients with asthma, heart block, or severe peripheral vascular disease. Beta blockers work by reducing neuronal excitability and modulating serotonin receptors, which helps prevent migraine attacks, and are particularly effective for patients with comorbid hypertension or anxiety 1.
From the FDA Drug Label
The initial oral dose is 80 mg propranolol hydrochloride extended-release capsules once daily. The usual effective dose range is 160 to 240 mg once daily. The dosage of beta blockers for migraine prophylaxis is:
- Initial dose: 80 mg once daily
- Effective dose range: 160 to 240 mg once daily 2
From the Research
Dose of Beta Blockers for Migraine Prophylaxis
- The optimal dose of beta blockers for migraine prophylaxis should be determined on a case-by-case basis, by increasing the daily dosage gradually 3.
- Low doses of propranolol, close to or up to 1 mg/kg body weight daily, are effective in controlling serious migraine bouts in many patients 4.
- Fewer than a third of patients will need higher doses to control migraine attacks 4.
- The choice of beta blocker and dose depends on several considerations, including possible side effects, associated pathologies, and the type of migraine 5.
Specific Beta Blockers and Doses
- Propranolol 80 mg bid is a frequently used and inexpensive option 6.
- Atenolol 100 mg qd is less expensive than long-acting propranolol 160 mg and nadolol 120 mg qd, with equivalent effectiveness 6.
- Metoprolol, timolol, and nadolol are also effective beta blockers for migraine prophylaxis, but the optimal doses are not specified in the studies 3, 7.