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Information on Beta Blockers
     

For a long time, Beta Blockers (Inderal, Tenormin, Corgard, Lopressor) have been a mainstay for the prevention of migraine and, to a lesser extent, tension headache. However, because of the propensity of these to cause weight gain (ugh!!), fatigue, increasing a person's asthma or shortness of breath, decreasing exercise tolerance, memory problems or 'spaciness', and general listlessness, these drugs have receded in popularity.  They do remain very useful in many patients.  In general, the preventive meds do not work for everyone, and we have not had an influx of newer preventives (unlike the situation with abortive headache stopping medication where many advances are being made).

One key with beta blockers is to utilize small doses. These drugs are also used to slow the heart down, to lower blood pressure, and in a number of other conditions. Thus, if someone needs a preventive med. and they have too fast a heartbeat or high blood pressure, a beta blocker may be a good choice.  Beta blockers also help anxiety and panic attacks in some people.

The generics of these generally are about as effective as the 'regular' medicine.  This is not true with all headache drugs, as some of the pain meds (ex. Fiorinal) are more effective in the 'real', non-generic variety.

Most of the beta blockers work for headaches, and we use various ones.  Inderal (propranolol) is the "prototype" in this class, but it's long-acting version is a capsule, rendering dosage changes somewhat difficult. The once per day versions of drugs are very convenient, so we try and use the long-acting forms....actually, the short-acting versions sometimes work better, such as 4 times a day Verapamil or 4 times a day Inderal, instead of the long-acting once per day version BUT...

1. who can remember to take meds 4 times a day, and
2. when treating headache patients, we must remember that we are always treating the FAMILY also, as headaches and the meds affect the entire family. So, when a spouse notices their husband or wife taking meds ALL the time, they tend to get upset, and we must minimize the number of doses. Spouses do not generally differentiate between Tylenol and narcotics, they simply say "Doc, my husband or wife is ALWAYS taking medicine!!".

Inderal (propranolol) is usually dosed at 60 or 80mg of the LA (long acting) version. We will occasionally go up to 120, 160, or higher doses.  However, with higher doses, fatigue and decreased exercise tolerance becomes a problem. At times, we will decrease to small doses, 20mg twice per day or even less.  If someone is on a beta blocker for more than a short period of time, it is important to slowly taper, or wean, off of it.This becomes increasingly important as people get older, because just stopping the drug cold can lead to a fast heartbeat for awhile, which is dangerous with increasing age.

The various other ones are used as well, from Tenormin (atenolol) to Corgard (nadolol) to Lopressor (metoprolol) to Blocadren. They should all be initiated with small doses.  These are tablets, rendering dosing changes fairly easy. We usually use these 3 once per day, but many patients do better with 2 times a day dosing.  At times, if one beta blocker does not work, another may be effective.