Timolol eyedrops reduce acute migraine in some patients

By John Murphy, MDLinx
Published June 21, 2018

Key Takeaways

Ophthalmologists have been prescribing timolol eyedrops for decades to reduce intraocular pressure in patients with glaucoma. Now, neuro-ophthalmologists have found that the ophthalmic beta-blocker can also reduce the severity of migraine headache in some patients. They recently reported their results in JAMA Neurology.

Several oral beta-blockers are already approved to prevent migraine. However, they’re absorbed gradually and delayed by metabolism, so they’re not effective treatments for acute migraine.

But timolol eyedrops, “provide a rapid route of delivery with the maximum plasma concentration achieved within 15 minutes of administration,” wrote the researchers, led by Sean Gratton, MD, assistant professor, Department of Neurology and Cognitive Neuroscience, University of Missouri–Kansas City School of Medicine, Kansas City, MO.

“This pharmacokinetic advantage supports a potential role for timolol eyedrops in managing acute migraine,” Dr. Gratton and coauthors wrote.

To investigate this possibility, the researchers conducted a small randomized, crossover, placebo-controlled trial of 10 adults who had been diagnosed with migraine (with or without aura). Patients were randomly assigned to 1 drop of either timolol maleate 0.5% or artificial tears in both eyes at the onset of migraine and 30 minutes after onset. Participants were seen monthly for 4 months and switched therapy after 2 months.

The patients had a combined total of 198 migraine attacks. For each migraine, patients were required to rate its severity on a scale of 0 to 3. At the end of the study, they rated the effectiveness of each drop on a scale of 1 to 4.

Overall, patients gave timolol an effectiveness rating of 2.4, compared with 1.4 for placebo. Four patients said timolol was highly effective compared with placebo, while one patient said the opposite. Among patients taking timolol, 67% of migraines had a severity of “none” or “mild” at 2 hours compared with 78% for placebo, a difference that was not significant (P = 0.26).

One patient developed a branch retinal artery occlusion while taking placebo, which the researchers believed was unrelated to the study. No other adverse events, including
hypotension or bradycardia, were observed.

“Timolol is an effective abortive treatment for some patients with migraines,” Dr. Gratton and coauthors wrote. “Future research should focus on identifying which patients will respond and at what dosage.”
The team calculated that a future study would require at least 172 randomized participants or 86 crossover participants to be sufficiently powered.

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