Treatment with propranolol

The preparation

Propranolol was developed to treat cardiovascular conditions, but scientific studies have shown that it can also be effective for migraines.

Mechanism of action

It is well known that a medication can be effective for more than one condition. When we prescribe Propranolol for you, it is not to lower your blood pressure, but to treat your migraine. The preventive effect of Propranolol may come from it stabilizing the blood vessels, but the exact mechanism of action is unknown.

Side effects

The most common side effects are fatigue, dizziness, a drop in blood pressure when changing position, nausea, abdominal pain, diarrhea, constipation, cold hands and feet, slow pulse, palpitations, and difficulty breathing.

Precautions

Propranolol should not be used for certain types of heart conditions, such as conduction disorders. It should be used with caution or not at all if you suffer from diabetes or asthma. It should also be used with caution if you are taking certain other medications, especially other heart medications.

Before starting treatment

Before you start treatment, an electrocardiogram (ECG) must be performed, and your pulse and blood pressure must be measured.

What is the dosage?

Start by taking 20 mg twice a day for 1 week. After that, increase the dose to 40 mg twice daily.

If the effect is insufficient – and there are no bothersome side effects after 1 month – increase to 60 mg twice daily for 1 week, and then further to 80 mg twice daily. Stay at the dose where you experience the best balance between effect and side effects – usually between 80 and 160 mg daily. However, you can go up to 240 mg per day.

If there is no effect after 1 month at 160 mg per day, it can be concluded that the medication does not work for you. You can then taper off by 40 mg every 3–7 days until you have stopped taking the medication completely.

Once the correct final dose is found, it should be taken daily for 6–12 months, after which the dose can often be slowly tapered off in consultation with your doctor. Some patients, however, need to use propranolol for several years.