Recalling My Role in Propranolol Research in Migraine Preventive Therapy
Seymour Diamond , MD Chicago , IL
As my headache practice grew during the 1970s , I was always keen on identifying new options for migraine prevention . An article on the use of the beta blocker , propranolol , in angina pectoris , was published by Rabkin and his colleagues in 1966 , and incidentally reported on a patient who had managed to control his migraine attacks while being treated with propranolol . In 1972 , in the journal , Neurology , Weber and Reinmuth expanded our knowledge of the topic by describing their work using propranolol for a group of migraine patients . These articles piqued my curiosity and by 1973 , I had begun prescribing propranolol for some of my patients , although the drug had not been approved by the Food and Drug Administration ( FDA ) for migraine prevention .
In my clinical practice , patients treated with propranolol were reporting significant decreases in the frequency and duration of their migraine attacks . Subsequently , I contacted Ayerst Laboratories , the manufacturers of propranolol , and suggested that they undertake clinical studies on propranolol use in migraine , in order to obtain approval by the FDA for that indication . Rudy Widemark , MD , was the physician supervising research at Ayerst , and he visited my office and agreed to initiate these studies . Through our collaboration , Dr . Widemark and I became friends . Later , when Rudy joined the staff at the FDA , he invited me to serve as a headache consultant .
With my colleague , Jose L . Medina , MD , I published the results of a study involving 83 patients who used either propranolol or placebo for migraine prevention . Sixty-two patients completed the study . The article was published in the March , 1976 , issue of the journal , Headache . Later that year , I traveled to Bethesda , MD , at the invitation of the FDA to appear before a panel of noted neurologists from across the US . At that meeting , I discussed the results of my study as well as that of John Graham , MD , of Faulkner Hospital , Boston .
Despite the small number of patients involved in the two studies , the indication for propranolol use in migraine prevention was approved . However , the panel limited the indication to non-classical migraine ( migraine without aura ). At first , I wanted to argue the point because there were few patients in the 1976 study who were diagnosed with classical migraine ( migraine with aura ). Subsequently , I considered my argument carefully because at that time , there was little consensus in the medical community that both types of migraine acted similarly . Also , I did not want to stall the approval process for propranolol .
During the next decade , we continued to study the long-term use of propranolol as well as a long-acting form of the drug to ensure patient compliance with a once-daily dose . Propranolol is probably the most widely used drug in migraine prevention . In the accompanying article by the group at the Headache Care Center , the suggested novel approach to acute migraine therapy with a beta blocker ophthalmic solution may provide significant help to migraine patients . And it can easily trace its roots back to an incidental finding in 1966 . HW
Suggested reading Diamond S , Medina JL . Double blind study of propranolol for migraine prophylaxis . Headache 1976 ; 16:24-27 .
Diamond S , Solomon GD , Freitag FG , Mehta ND . Long-acting propranolol in the prophylaxis of migraine . Headache 1987 ; 27:70-72 .
Rabkin R , Stables DP , Levin NW , et al . The prophylactic value of propranolol in angina pectoris . Am J Cardiol 1966 ; 18:370-380 .
Weber RB , Reinmuth OM . The treatment of migraine with propranolol . Neurology 1972 ; 366-369 .
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