Propranolol reduces the frequency, severity, and duration of headaches in patients with episodic migraine and tension-type headaches, according to a study published in PLoS One.
In this systematic review and meta-analysis, researchers sought to assess the efficacy of beta blockers in preventing migraine and tension-type headache. A literature search including 3513 studies through August 21, 2018, was conducted using the Cochrane Central Register of Controlled Clinical Trials, MEDLINE, EMBASE, ISI Web of Science, clinical trials registries, and 3 Chinese databases (China National Knowledge Infrastructure, Wanfang, and Chongqing VIP Information Co., Ltd.).
Randomized controlled studies of ≥4 weeks in duration that used a β-blocker in at least 1 study arm were included (n=108), which included placebo-controlled (n=50) and comparative effectiveness trials (n=58). Articles were reviewed by at least 2 investigators to determine whether headaches could be classified as migraine or tension-type headache, and as either episodic or chronic. The primary outcome was monthly headache frequency pooled as headache days per month. The secondary outcomes were headache index, severity, duration as headache hours per month, quality of life, the use of acute analgesic medications as the number of doses per month, the proportion of ≤50% improvement in headaches, withdrawals from the study, and occurrence of adverse events. A network meta-analysis was performed to compare β-blockers with placebo at 8 and 12 weeks.
Propranolol reduced episodic migraine headaches by 1.5 headaches per month compared with placebo at 8 weeks (95% CI, -2.3 to -0.65) and was more likely to reduce headaches by approximately 50% (relative risk [RR] 1.4; 95% CI, 1.1-1.8). Propranolol was also more likely to reduce headaches by ≤50% (RR 2.0; 95% CI, 0.94-4.3) in patients with chronic migraine; none of the 4 trials evaluating β-blockers for chronic migraine were placebo-controlled. Trials that compared β-blockers with other interventions were mostly single, underpowered trials. There was 1 trial of β-blockers used to treat tension-type headache in which researchers found that pindolol and amitriptyline were more effective in reducing headache frequency at 4 to 8 weeks by ≤50% than placebo (RR 3.8; 95% CI, 1.5-9.3), but was equally effective to amitriptyline alone.
This study is limited by significant methodological problems in combining the results of poorly designed studies. Several studies were inconsistent in reporting outcomes.
Propranolol was found to be effective in reducing headaches from 5 to 3 headaches per month. More research is needed to test the efficacy of β-blockers against other commonly used prophylactic regimens.
Jackson JL, Kuriyama A, Kuwatsuka Y, et al. Beta-blockers for the prevention of headache in adults, a systematic review and meta-analysis [published online March 20, 2019]. PLoS One. doi: 10.1371/journal.pone.0212785