Treatment with propranolol

The medication 

Propranolol was developed to treat heart and circulatory 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 therefore not to lower your blood pressure, but to treat your migraines. The preventive effect of Propranolol may come from its ability to stabilize blood vessels, but the exact mechanism of action is not known.

Side effects 

The most common side effects are fatigue, dizziness, a drop in blood pressure when changing positions, nausea, abdominal pain, diarrhea, constipation, cold hands and feet, slow pulse, heart 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 types of medication, 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 dosage should be taken 

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

If there is insufficient effect – and if 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 has been 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.