Beta Blockers, such as propranolol or nadolol are one of the first steps in using medications in migraine prevention. I like to start with them first, not only because they are effective and have low side effects, but they also have other health benefits. We know that they tend to protect the heart from heart attacks, especially in people who have had previous heart attacks. Beta blockers can also help with some of the philological aspects of anxiety. But now a new study shows that they may also protect the brain (see here).
Of course Beta blockers are not perfect and they are real, meaning they do real things, so they can have real side effects. The most common one is fatigue. But over all they have less side effects than most of the other medications we use to prevent headaches.
I have to say at this juncture that here in the Pacific Northwest there is a prevailing philosophy among laypeople that medications are evil or even immoral. I come up against this all the time which greatly handicaps my ability to help people. Having worked in medical care on almost every corner of the world, I would have to say this attitude is unique to the Pacific Northwest. It is a philosophical and almost religious view and not one based on research.
Recently I wanted to start a patient on a beta blocker and she refused. She had done every “natural” treatment for headaches that are possible with no benefit. However, she refused to take the beta blocker because her “natural” health care provider told her that beta blocker damage the heart and cause live cancer. Both of these statements are total fabrications. This statement was made by someone who has never studied medications and doesn’t know anything about them but patients tend to believe this misinformation. It was regrettable because not only could they really have helped her headaches but she also suffered from hypertension (the original purpose for beta blockers). I am confident that the beta blocker would help her to live a much longer and productive life.
The main contraindication for taking beta blockers is reactive airway disease (asthma).