Timolol Eyedrops for Acute Migraine Attacks
Published online May 14, 2018
The oral beta-blockers approved for migraine prophylaxis may not be effective for acute attacks because of slow absorption and modification by first-pass metabolism, which delays effective plasma levels for hours or even days. With timolol eyedrops, maximum plasma concentration is achieved within 15 minutes of administration. In a pilot study, Cossack et al. tested the effectiveness of the eyedrops as an abortive migraine treatment and found it helpful for some patients.
This placebo-controlled crossover study was conducted among 10 adults with recurrent migraine, with or without aura, who were recruited from the authors’ neurology and ophthalmology clinics. Patients were assigned randomly to receive timolol maleate 0.5% or artificial tears (placebo) and were instructed to insert 1 drop in each eye at migraine onset and 30 minutes later. The participants were seen monthly for 4 months (5 visits per patient). After a 3-day washout at the 2-month mark, they were switched to the opposite treatment arm. Patients ranked the severity of each migraine attack on a scale of 0 (least) to 3 (greatest) and rated the effectiveness of each treatment on a scale of 1 (least) to 4 (greatest).
Among the 10 patients, 198 migraine attacks occurred during the study period. Four patients reported that timolol was highly effective in comparison to placebo; another patient noted the opposite. Thirty-seven (67%) of 55 migraines that occurred during timolol use had severity of none to mild at 2 hours, versus 58 (75%) of the 77 migraines during placebo use. No adverse events were observed during the study.
The original article can be found here.