Metoprolol in the Prophylaxis of Migraine: Parallel‐Groups Comparison withPlacebo and Dose‐Ranging Follow‐Up

Abstract

SYNOPSIS 88 patients in need of prophylactic treatment for classical, common or mixed migraine of at least 2years' duration were admitted to a double‐blind placebo‐controlled trial of the beta1‐selective adrenoceptorblocker, metoprolol. All patients initially took placebo for 1 month, during which 29 were excludedprincipally because of failure to reattend or placebo‐response making active treatment unnecessary. Theremaining 59 patients were randomised to continued placebo or metoprolol 50 mg b.i.d. for 2 months.Patients after this time subjectively categorizing their responses as less than optimal changed,double‐blindly, from placebo to metoprolol 50 mg b.i.d., or from metoprolol 50 mg b.i.d. to 100 mg b.i.d., fora further follow‐up period of up to 3 months. Placebo response was 40% overall, and often occurred after the first month. In the first double‐blindcomparative period metoprolol reduced attack frequency significantly, and more than placebo. Severity ofattacks still occurring was not altered by either treatment. Other measures of illness were alteredconsistently with these principal findings. Consistent improvements also were seen in patients switchingfrom initial placebo therapy to metoprolol 50 mg b.i.d. for the further follow‐up period, and those changingto the higher dose of metoprolol showed statistically significant further improvements, and clinicallyimportant improvements overall. Side‐effects were minor and reversible. This study gives supportive evidence of the value of metoprolol in preventing migraine attacks andsuggests that individual dosage titration can substantially enhance its efficacy. Side‐effects do notsignificantly impede its use and other evidence suggests that beta1‐selective blockers are to be preferredover non‐selective in migraine therapy.

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).…”

Die medikamentöse Prophylaxe der Migräne

“…In placebokontrollierten Studien konnte eine migräneprophylaktische Wirksamkeit für Propanolol [13,18,22,23,37,38,44,52,55,57,61,74,78,79], Metoprolol [3,29,30,37,52,68,73,75,77], Timolol [65,74], Nadolol [55] und Atenolol [36,61] …”

Therapie der Migräneattacke und Migräneprophylaxe

“…Sicher wirksam für die Prophylaxe der Migräne sind der nicht-selektive Beta-Blocker Propranolol [36] und der Beta-1-selektive Beta-Blocker Metoprolol [40,57,75,77] (Tabelle 7). Bisoprolol ist wahrscheinlich ebenfalls wirksam, wurde aber nur in wenigen Studien untersucht [97,105].…”