Topical timolol prevented migraine attacks

Bhagey, Joy; James, Bruce

doi:10.1038/sj.eye.6701303

Cited by 7 publications

(5 citation statements)

References 6 publications

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“…Topical timolol maleate 0.5% reaches a concentration of 0.5 ng/ml in the plasma within 4 h of dosing [4] and has been reported to reduce the frequency and symptoms of migraine [5,6]. Timolol has also been shown to attenuate the detrimental effect of ischaemia [7].…”

Section: Discussionmentioning

confidence: 99%

Topical beta-blocker treatment for migraine

Chiam

2012

Int Ophthalmol

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Beta-blockers are a well-known prophylactic treatment for migraine; however, treatment by the ocular route has not been widely considered. This case illustrates the resolution of a visual field defect associated with migraine and improvement of symptoms possibly due to administration of a topical beta-blocker. This novel method of treatment especially when visual field defects are present may have a place in the management of migraine.

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Section: Discussionmentioning

confidence: 99%

Topical beta-blocker treatment for migraine

Chiam

2012

Int Ophthalmol

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“…A review of the literature shows that all previous publications describing the beneficial effects of β-blocker eyedrops for the treatment of migraine headaches are sporadic isolated case reports. The literature collectively [9][10][11][12] suggests that the success of β-blocker eyedrops in treating acute migraine may be a result of the rapidity of eyedrops in achieving effective blood levels when instilled shortly after symptom onset.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, topical timolol is a time-tested drug widely used in the treatment of glaucoma. Literature on using β-blocker eyedrops to treat migraine headaches is sparse and consists of only isolated case reports . A 2014 case report by Migliazzo and Hagan substantiated the success of using β-blocker eyedrops to treat acute migraine but was a small case series of only 7 patients.…”

Section: Introductionmentioning

confidence: 99%

Short-term Efficacy and Safety of Topical β-Blockers (Timolol Maleate Ophthalmic Solution, 0.5%) in Acute Migraine

et al. 2020

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IMPORTANCE Oral β-blockers used for the prevention of migraine headache are not effective for the treatment of acute pain. Small case series have suggested that topically applied β-blockers may be useful in the management of acute migraine pain, warranting evaluation with randomized clinical trials.OBJECTIVE To evaluate the short-term efficacy and safety of topically applied timolol maleate ophthalmic solution, 0.5%, compared with topically applied placebo eyedrops in the treatment of acute migraine attacks. DESIGN, SETTING, AND PARTICIPANTSIn this randomized, masked placebo-controlled crossover trial conducted from May 27, 2015, to August 28, 2017, 50 patients with migraine were randomized to receive either timolol eyedrops, 0.5%, or a placebo eyedrop (carboxymethyl cellulose, 0.5%). After a 3-month treatment period, patients completed a 1-month washout period and were crossed over to receive the opposite treatment for a final 3 months. Analysis was performed on a modified intent-to-treat basis.INTERVENTION After random assignment, patients were instructed to use 1 drop of the assigned medication in each eye at the earliest onset of migraine. MAIN OUTCOMES AND MEASURESThe main outcome measure was reduction in pain score with treatment. The primary end point was reduction of pain score by 4 points, or to zero, 20 minutes after instillation of the eyedrop. RESULTSOf the 50 patients, 42 (84%) were females and the mean (SD) age was 27.3 (11.3) years. Of a total of 619 migraine attacks, 284 (46%) were treated with timolol, 271 (44%) were treated with the placebo, and 64 (10%) occurred during the washout period when no study medications were used. Seven patients (14%) withdrew after randomization. A total of 233 of the timolol-treated migraine attacks (82%) were associated with a reduction in pain score by 4 points, or to zero, at 20 minutes compared with 38 of the placebo-treated attacks (14%), with a difference of 68 percentage points (95% CI, 62-74 percentage points). A generalized estimating equation analysis revealed that pain score reduction at 20 minutes was greater in the timolol group compared with the placebo group by a mean (SE) of 4.63 points (0.34) (P < .001).CONCLUSIONS AND RELEVANCE This randomized crossover trial supports consideration of timolol eyedrops in the acute treatment of migraine. Further research is warranted to determine if the improvements observed are sustained for a longer follow-up and with larger groups.

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“…Topical ocular beta blockers when used daily have been reported to prevent migraine attacks. [13][14] The specific aims in this study were to 1) assess the efficacy (headache freedom at 120 minutes) of timolol 0.5% ophthalmic solution compared to placebo in acute treatment of migraine headache; and 2) assess the safety and tolerability of timolol 0.5% ophthalmic solution in treatment of acute migraine headache.…”

Section: Discussionmentioning

confidence: 99%

A Randomized, Double-Blinded, Placebo-Controlled, Cross Over Study Evaluating the Efficacy and Safety of Timolol Ophthalmic Solution as an Acute Treatment of Migraine

Aggarwal

Heim

Bittel

et al. 2020

kjm

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Introduction. Daily oral beta-adrenoreceptor antagonist has been shown to be effective in preventing migraine headaches. Timolol 0.5% ophthalmic solution is a non-selective beta-adrenoreceptor antagonist, where the primary use is for glaucoma. There have been case reports that timolol is effective in aborting or improving an acute migraine headache. The objective of this study was to assess the efficacy (decrease of ≥ 50% in pain scale at 120 minutes) of timolol 0.5% ophthalmic solution compared to placebo in acute treatment of migraine headache. Methods. x We performed a randomized, double-blind, crossover, placebo-controlled, study. Study entry criteria required subjects to have one to eight migraine episodes per month. The primary outcome was comparison of the change in a visual analog pain scale (VAS) at 120 minutes after taking the study medication. Study subjects were given a pain scale with a range of 1 (no pain) to 10 (most severe pain) to complete after onset of migraine but before administration of study drops and 120 minutes after administration of study drops. Improvement was defined as a ≥ 50% decrease in pain scale. Results. Nineteen subjects completed the study and were used for analysis. The primary outcome changes in pain scale, 120 minutes after dose, showed a similar decrease for placebo and drug with a slightly wider 95% CI for placebo. Six subjects in each arm experienced a ≥ 50% decrease in pain scale. Conclusion. These results support that timolol 0.5% ophthalmic solution is not an efficacious treatment for acute migraine headache.

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Topical timolol prevented migraine attacks

Cited by 7 publications

References 6 publications

Topical beta-blocker treatment for migraine

Topical beta-blocker treatment for migraine

Short-term Efficacy and Safety of Topical β-Blockers (Timolol Maleate Ophthalmic Solution, 0.5%) in Acute Migraine

A Randomized, Double-Blinded, Placebo-Controlled, Cross Over Study Evaluating the Efficacy and Safety of Timolol Ophthalmic Solution as an Acute Treatment of Migraine

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