• Timolol Eyedrops for Acute Migraine Attacks

    Written By: Lynda Seminara
    Selected By: Deepak P. Edward, MD

    Journal Highlights

    JAMA Neurology
    Published online May 14, 2018

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    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.