Oral β-blockers have been used for migraine headache prevention, but they haven’t been shown to effectively treat acute pain. Some small case series, however, have suggested that topical β-blockers might help when an acute migraine strikes.

To better investigate topical β-blockers’ short-term efficacy and safety, a recent randomized clinical trial compared topical timolol maleate ophthalmic solution 0.5% with placebo eyedrops for acute migraine attacks. The crossover trial included 50 patients (84% female, mean age 27.3±11.3) with migraine, randomized to receive either timolol eyedrops or a placebo (carboxymethyl cellulose 0.5%). The three-month treatment period was followed by a one-month washout. After the washout, patients received the opposite treatment for another three months.

The 50 patients suffered a total of 619 migraine attacks during the study, of which 284 were treated with timolol, 271 with placebo and 64 occurred during the washout period and received no study medications. Seven patients withdrew from the trial after randomization.

The researchers found that 233 timolol-treated migraine attacks were associated with a reduction in pain score by four points, or to zero, after 20 minutes, compared with the 38 placebo-treated attacks. Overall, the pain score reduction after 20 minutes was significantly greater in the timolol group.

The researchers concluded that their crossover trial supports “consideration of timolol eyedrops in the acute treatment of migraine.” They added that further research with larger study populations and longer follow-up periods is needed.

Kurian A, Reghunadhan I, Thilak P, et al. Short-term efficacy and safety of topical β-blockers (timolol maleate ophthalmic solution, 0.5%) in acute migraine: A randomized crossover trial. JAMA Ophthalmology. October 1, 2020. [Epub ahead of print].