Acute migraine sufferers may have a new treatment option to alleviate their symptoms: glaucoma drops, or more specifically, timolol.
While oral beta blockers are approved for migraine prophylaxis, researchers from the University of Missouri-Kansas City noted their delayed effect for hours to days, limiting their use in acute migraines. However, timolol eye drops provide a rapid route of delivery with achievement of the maximum plasma concentration within 15 minutes of administration, says researcher Matthew Cossack, MD.
In a small, randomized, crossover, placebo-controlled pilot study, investigators evaluated 198 migraines from 10 adult patients. Participants were placed in the timolol maleate 0.5% or an artificial tears group and received one drop in both eyes at onset and again 30 minutes later. They were then asked to rate their migraine attacks in terms of severity on a scale of zero to three at two hours. In the timolol group, 78% said they had mild to no symptoms compared with 67% in the placebo group. At the end of the study, the subjects rated the effectiveness of each drop on a scale of one to four, with a mean of 2.4 in the timolol group compared with 1.4 in the placebo.
One patient in the placebo group developed a branch retinal artery occlusion, but the investigators cited the condition was not related to the study. No other adverse occurrences—including bradyardia or hypertension—were reported.
The study helps support the anecdotal experience that timolol eye drops are beneficial to some migraine sufferers as an abortive treatment, Dr. Cossak says. Given the small sample size of this unfunded pilot study, there are no statistically significant results and further studies are needed, he adds.
“To further emphasize the possibility of placebo effect (or dry eye), one patient found such benefit from the artificial tear arm that she wished to replace all her migraine medications with the drops. Four of ten patients, however, found timolol to be highly effective. We hope further studies can determine which patients will respond,” Dr. Cossack says.
|Cossack M, Nabrinsky BA, Turner H, et al. Timolol eyedrops in the treatment of acute migraine attacks. JAMA Neurol. March 14, 2018. [E-pub ahead of print].