Would Beta Blocker Eye drops Be a Breakthrough for the Acute Treatment of Migraine ?
Currently , the medications used to treat acute migraine generally are either triptans or nonsteroidal antiinflammatories ( NSAIDs ). Triptans act by constricting blood vessels and blocking the release of calcitonin generelated peptide ( CGRP ) from the nerves activated during migraine . CGRP cause blood vessels to swell and initiates the cascade of inflammatory events leading to pain . The NSAIDs are believed to work primarily by blocking the synthesis of another inflammatory pathway mediated by prostaglandins . If beta blockers are found to be an effective acute treatment for migraine , their efficacy would likely be due to a novel mechanism ( s ) and provide a third line of potential treatment success . This finding would undoubtedly represent a major medical advancement for the acute treatment of migraine .
Also , because beta blockers are already used on a daily basis to prevent migraine , it is unlikely that their frequent use to treat acute migraine would be associated with medication-overuse headache . This finding would be welcome news for those individuals with high treatment requirements . The beta blocker eye drops also would likely have a good tolerability profile as the dose of actual medication received would be quite low relative to oral beta blocker therapy . Clearly , the need to obtain good clinical trials is indicated before making claims for their use or safety .
What Are the Risks and Limitations ?
Oral beta blocker therapy is not tolerated by everyone . Beta blockers can lower blood pressure and slow the heart rate . These effects have been occasionally noted with beta blocker eye drops as well . Rarely , beta blockers can have an adverse effect on asthma . Finally , for those patients with diabetes who are prone to hypoglycemia ( low blood sugar ), beta blockers can mask some of the warning symptoms and would have to be used with caution . However , beta blockers , and in particular timolol , have been used for decades on a daily basis for treatment of glaucoma , and are generally well-tolerated even with daily use . It is assumed that as an acute treatment for migraine , the beta blocker eye drops would be used on an intermittent basis which should increase their tolerability . In the future , studies may be conducted on the administration of beta blockers as a nasal spray .
What Are the Next Steps ?
As with any new potential treatment , the next step is rigorous clinical studies . However , much of the initial work has probably been accomplished , and can be extrapolated from completed studies of beta blocker in glaucoma patients and in migraine patients using beta blockers for migraine prevention . However , the initial step is to undertake a pilot study to establish a proof of concept that timolol eye drops are indeed effective as acute treatment of migraine . If that conclusion can be established , large clinical trials must be undertaken to further establish efficacy and safety of their use in acute migraine . Efforts are currently underway to conduct a pilot proof of concept study . If the proof of concept is established , then involvement of the FDA will be needed before the beta blocker eye drops could be an approved treatment of acute migraine .
references
Hagan JC III . Are drops the ‘ solution ’? A Eureka moment ? Beta blocker eye drops for acute migraines . Missouri Med 2014 ; 111:281-283 .
Migliazzo CV , Hagan JC III . Beta blocker eye drops for treatment of acute migraine . Missouri Med 2014 ; 111:284-289 .
Dexter JK , Cady RK . Ophthalmic beta blockers : Treatment for acute migraine ? Missouri Med 2014 ; 111:293-294 . HW
18 HeadWise ® | Volume 5 , Issue 1 • 2015