Classic Migraine: Effective Prophylaxis with Metoprolol

Abstract

Metoprolol slow-release tablets (Durules), 200 mg, given once daily in the morning were compared with placebo in the prophylaxis of classic migraine. The trial comprised eight Scandinavian neurologic centres and was designed as a double-blind cross-over study with 4 weeks' run-in, four weeks washout, and 8 weeks of either treatment. Seventy-seven patients with two to eight migraine attacks per month were entered in the trial, and 73 completed it. A total of 1119 attacks with aura symptoms and 374 without were recorded. Metoprolol was significantly better than placebo with regard to the total frequency of attacks (1.8 versus 2.5 attacks/4 weeks), mean duration of attacks (6.0 versus 8.0 h/attack), mean global rating, and consumption of analgesics per attack. Similar differences could be shown for attacks with aura symptoms alone, except for the duration of attacks. Metoprolol is the first drug for which a prophylactic effect in classic migraine has been convincingly demonstrated.

Bisoprolol and Metoprolol in the Prophylactic Treatment of Migraine with and without Aura - A Randomized Double-Blind Cross-Over Mulitcenter Study

“…A decrease from baseline in the number of attacks was seen which is in line with the results for metoprolol obtained from placebo-eontrolled double-blind studies (2,3,4) …”

Adverse effects of medications commonly used in the treatment of migraine

“…The mechanism of action of these medications is unclear for migraine; current hypotheses include effects on the central catecholaminergic system and inhibition of CSD [38,67]. Other b-blockers that work for migraine prophylaxis include nadolol, atenolol, bisoprolol, metoprolol and nebivolol [68][69][70][71][72].…”

Optimizing prophylactic treatment of migraine: Subtypes and patient matching

“…Propranolol is considered to be the reference prophylactic treatment for migraine. Other β-blockers which have demonstrated superior efficacy for migraine prophylaxis compared to placebo include metoprolol (Kangasniemi et al 1987; Steiner et al 1988), timolol (Tfelt-Hansen and Olesen 1984; Stellar et al 1984), altenolol (Forssman et al 1983; Johannsson et al 1987) and nadolol (Freitag and Diamond 1984). Comparable efficacy to propranolol has been shown for all four of these drugs (Kangasniemi and Hedman 1984; Olsson et al 1984; Tfelt-Hansen and Olesen 1984; Stensrud and Sjaastad 1980; Ryan 1984; Sudilovsky et al 1987).…”