Is propranolol the best beta blocker?

(1) Does Propranalol have special anti-migraine/vertigo properties out of all the beta blockers?

(2) Wikipedia shows Propranolol is a non-selective beta blocker.

Do other beta blockers within the same class (such as Nadolol or Alprenolol) give equally good anti-migraine/vertigo results?

(3) Is it right to assume that the other types of beta blockers shown in Wikipedia are not as good for migraines/vertigo?

I think there is literature to suggest some beta blockers over others in treatment of migraine. I started on propranolol by ent and my neuro switched me to nadolol saying it has fewer side effects. I wasn’t on the propranolol for more than a week so I can’t really compare the two. I still take the nadolol and it’s helped.

From what I remember Propranolol is the one doc’s seem to like most, its the only one FDA approved for Migraine and on the Hain site, he shows it to be very effective.

Im on 10mg now. I know, my dose is way lower than its supposed to be. But Im very sensitive and already have good low/normal BP.

I have noticed after 1 dose, that it has helped my dizziness. Im also on Nortriptyline 12.5mg and have been on it for almost 8 weeks.
I thought the 1 dose had to be a coincidence, but I have been on it now for 9 days, and the last 9 days I would say it put me at about 85% with the dizziness.
I was at about 60-7-%.

Hasnt helped with headache. I have had one for about 2 weeks, but I believe mine to be both hormonal, and cervical related. As my headache is fine, then I turn my head a certain way and bam pain, go back, ok, turn pain… etc…

Alot of folks say that the propranolol helped there headaches at around 30mg, but not the dizziness. So just shows we are pretty much the same boat, yet all need different oars. :slight_smile:


I take a selective beta blocker (metoprolol / Lopressor) and it’s taken me from 30% to 70-80% …

Hi there,

There is no difference in efficacy from the five main non-sympathomimetic beta-blockers. All are equally effective for migraine. They are:

  1. propranolol
  2. timolol
  3. nadolol
  4. atenolol
  5. metoprolol

Professor James Adleman from the Headache and Wellness Centre in North Carolina prefers atenolol (inexpensive; can be given once daily, typically at night; fewer side effects such as depression).

Note: the end point for beta-blockers is a pulse rate in the low 70s or upper 60s, and the dose is determined accordingly. In studies, 45% to 60% of patients reported 50% reduction in headaches on these medications.

Let me know if you have any more Qs about this.

Scott 8)

— Begin quote from "scott"

non-sympathomimetic beta-blockers.

— End quote

OK I’ll bite - in English this means… :lol:

Started 10 mg. of Propranalol exactly a week ago, first treatment for me. So far, it may have helped diminish dizziness and increase insomnia. But today I was excessively hungry and thirsty (very unusual). I’ll stick to it for now, but was wondering if this is a typical passing side effect?

p.s. I’m loving the vivid dreams; couldn’t think of a cooler side effect. It’s like going to the movies in my sleep. Not trying to take this lightly, just trying to keep my humor and stay positive (or maybe it’s the Cymbalta)…

After one month, I’m unsure about whether or not I’m on the right “cocktail.” Mostly because I feel very tired most of the time, which has made me sooo very sedentary; yuk:(! I manage to get through most work days OK and part of that is because my job demands my constant full attention, but once I leave it’s hard to get motivated to do anything else. The dizziness is still being kept at bay about 70% of the time (perhaps the small dosage begins to wear off towards the end of the day or under stress, but I don’t think it’s worth taking later in the day when I go to bed so early). The neck pain seems to be improving on its own, just in terms of severity, and I’ve had recent increased auras, some with dizziness, others without. So I have mixed feelings.

How do you know? How do you decide? Is it easier than finding your soul mate:)??? I’ll be seeing a Neurologist next week (second try, but at least she was recommended on this forum). Besides sharing my history and all the negative test results, I’m not even sure how I feel about this and am even afraid about advocating for a change. Just a year ago I felt so very young for my age and now I’m feeling so very old for my age and I think it’s mostly due to the change in my energy level…I long for that feeling of health and wellbeing…

Since June of 2012 I have been spiraling down from being dizzy once in awhile like in stores to all the time. No matter how quiet the environment I am still dizzy. Has anyone found anything to help with the dizziness? Is propranolol all you need or do you have to couple it up with cymbalta. I also have been suffering from a left ear that is alway under a lot of pressure. This pressure started July 2008 without any let up. I have seen countless doctosr for it and the diagnosis is sudden hearing lost. But no cure for the pressure and ringing it creates in my head. I think the years of pressure has put my brain in stress and that stress is being translated into dizziness. So I don’t know If my dizziness is migraine related or sudden hearing lost related. Or my sudden hearing lost was due to migraine to begin with and the dizziness is a new manifestation of the same disease.

I am seeing Dr. Rauch at Mass Eye and Ear infirmary in Boston. Has anyone gotten any good treatments from him? I have high hopes. I hope I am not disappointed. This dizziness has got to go. It makes working difficult and I took 2 days off from work this week. I returned today but it was difficult. I don;t go out by myself and I can’t enjoy any social event or even visiting my daughter. All I want to do I sleep because sleep is the only place where I don’t feel dizzy.

I had a very similar situation with you. Have been dizzy for 7 months, have seen around 9 docs without diagnosis. Finally I found a Prof diagnosed me MAV. He gave an antidepressant called Cipralex an also propranolol (20 mg). He told me that it’s all about the mineral balance in my inner ear which has been destroyed. And gave me a diet of salt, nuts, chocolate, kiwi, orange juice etc.(the things with lots of minerals, cafeinne and thein as well.) He said that through diet I will balance the destroyed minerals in my inner ear and if I can control the triggers make me feel dizzy like stress, sleeping less, hunger bla bla I will get over it. Maybe what you need is to find the right doctor and right diet and med for you. I hope all of us can get rid of this as soon as possible. It’s so difficult but try to stay calm and patient… (that’s what I cant do most of the time)

Hey Helen,

I started 160mg propranolol today.



I think Propranolol is one of the best for MAV. The neuro-oto left the choice of preventative to my own doctor and she chose beta blockers because my BP was high end of normal. Initially she chose Bisoprolol Fumerate which gave me severe GERD ( I have GERD dx.). I lasted three days. Then she gave me Propranolol so I consider myself quite lucky there. I was fine with Propranolol only having GERD symptoms once more early on when the pharmacist issued a different brand. One particular brand is now specified on my prescription, availability issues are the subject of separate thread but it’s all settled at the moment. I wish you so much luck with Propranolol as I’ve had. Helen

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This was written in 2013. From what I’ve read Propranolol seems to have bern most researched and is indeed many medics first choice of beta blockers even if beta-blockers don’t happen to be their first choice of drug for MAV anyway. One I saw was empathic Sodium Valproate was The Best Thing by far.

Which are:- Propranolol, Atenol, Nadolol, Timolol, Metropolol

It would be interesting to read more papers relating to the others but Propranolol gets the coverage. We have to bear in mind that was written in 2013 and things move on. I‘ve read very recently that Timolol eyedrops have recently been approved for acute migraine but that Timolol isn’t considered effective for prevention. It will be interesting to follow @flutters progress because I know she was previously taking Atenol which didn’t seem to help her MAV at all. I’ve spoken to others who took Metopolol to no effect which of course doesn’t mean anything much. It’s all so individual. They must all be pretty similar these beta-blockers because apparently it’s possible to do straight swops between them which surprised me.

Which is considered a success by medics still! Does seem rather low.

From my own experience I can well believe that. 30mg seems to have halted my vestibular attacks but it took 160mg+ to stop the 24/7 dizziness plus 8 months waiting time. Over a year on 130mg before that did nothing for the constant dizziness.

Same here. Lasted for years but almost gone now. I rather miss them. At least they weren’t nightmares. One added bonus though I appreciate you can get them on Venlafaxine and other drugs too. Helen

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Oh yeah, this one does the wake you up in the middle of the night nausea thing. Awesome. Maybe I’ll get lucky and that will counteract the weight gain effect. (Not that it ever has before. My metabolism is a sponge in the desert.)

Oh dear, Em sorry to hear that. I’ll plough back through my notes but don’t think so. Of course I titrated up real slow. And I was taking the Immediate Release stuff, still am. I cannot take capsules of anything. Has to be tablets. Seems something in the capsule coating causes me extreme GERD off the end of the scale. Once it starts, Goes on for days non-stop. I started out 10 mg, one three times daily then I’d add in another 10mg about once a week. Doctor said every fifth day but Helen had other ideas. Took me about 10 weeks to reach 130mg. I was particularly acute when I started, lots of symptoms and feeling nausea 24/7, from the MAV I assumed. Cannot remember when that stopped. I’ll see if I made a note. At that stage I would wake up regularly through the night because vertigo would occur when I turned over in bed and that would wake me. Did you titrate up slowly to 160mg? Helen

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No, as usual I simply jumped in with both feet. Plus, it went from one capsule to another capsule. (American insurance doesn’t let you get choosy about brands or types - it can change monthly.) I didn’t mind opening up Effexor and splitting them but I’m a bit afraid to do that with a beta blocker. My BP has been high since college.

I’m nauseous, dizzy, hot, the head pressure is building and the tinnitus is loud but to be fair to propranolol, I’ve been absolutely crashed out for days. I’m 6 days into my month long health sabbatical and was already feeling like shit. So really this is not much worse.

Oh good, I was hoping for diarrhea.

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So people with you cannot increase gradually then on it, ever. UK if lucky you can get specified brand if it’s listed in the script. I had terrible troubles there (see another thread) but they do see immediate release and XR as very separate, and don’t mix. In fact not to be mixed types which is something. I think we have our pharmacists to thank for that mainly.

I’ve been checking around. Dr Hain only uses XR and starts at 60mg according to his flowchart. If you read his notes he starts straight in at 80mg, no mention of titration and certainly nothing about opening capsules. So you are wise.

So you are taking one 60mg tablet anyway then took two 80mg last night. Is that how it goes? Any chance you could get to try two 60mg. Like you I was absolutely crashed out when I started on Propranolol. Couldn’t have been more crashed unless I had got hit by a steam roller rather than the proverbial truck.

I certainly have memories of nausea for weeks on end but little or no diary mention. As it was constant I guess it was just taken as read. Same with the 24/7 dizziness. Only time I mentioned it was when the light made it worse or to the point I’d fall over. I don’t associate it with the Propranolol at all though could be wrong. My diary entry for 27/11/2015, on 80mg for a few days by then reads:

Early am - in bed - felt nauseous - opened eyes in very dark bedroom on very dark winter’s morning. Noticed this couple of times on waking earlier than usual.

Thanks for the research. It’s one 160mg capsule with offensively bright dye and racing stripes. Not sure what that lunacy is about.

I’ll tough it out a week and then maybe ask to split the doses. I don’t do well with capsules either, but the health care system is immune to my complaints.

The only UK Site that recommends using Slow Release starts in at 80mg then just doubles it after two weeks, and then again to reach 240mg!

I wouldn’t be surprised if it isn’t the dye in the bright dye and racing stripes that’s the culprit. I know you cannot take fruit flavoured jelly. Helen

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