Timolol vs propranolol vs placebo in common migraine prophylaxis: a double-blind multicenter trial

ABSTRACT— Common migraine sufferers (25 males, 71 females) with a history of 2–6 attacks per month participated in a 4-centre trial comparing the prophylactic effect of timolol (10 mg b.i.d.) and propranolol (80 mg b.i.d.) to placebo. After a pretreatment period of 4 weeks they entered a double-blind 3-way cross-over trial with 3 treatment periods of 12 weeks each. 83 patients received all 3 treatments. The mean frequency of attacks per 28 days was 3.35** on timolol, 3.69** on propranolol and 4.83 on placebo. Mean severity of attacks (0–3) was 1.75 on timolol*, 1.83 on propranolol, and 1.93 on placebo. Mean duration of attacks was 7.41 h on timolol, 7.38 on propranolol and 7.95 on placebo. The headache index (frequency times severity) was 5.71** on timolol, 6.66** on propranolol and 9.03 on placebo (*P < 0.05, **P < 0.01 compared to placebo). The difference between propranolol and timolol was non-significant: frequency of attacks 0.34 (95% confidence limits - 0.26; 0.89). Headache index 0.95 (95% confidence limits - 0.43; 1.97). 38 patients on timolol, 35 patients on propranolol and 23 patients on placebo experienced side effects (P < 0.05). It is concluded that timolol and propranolol are equally effective in the used doses (1:8) for common migraine prophylaxis.