Timolol Eyedrops Effective in Some Patients With Acute Migraine

Jaime Rosenberg

The FDA has previously approved multiple oral β-blockers for migraine prophylaxis; however, their use is limited to acute migraines. A recent study, published in JAMA Neurology, investigated the use of timolol eyedrops as an acute migraine treatment.

“Timolol eyedrops provide a rapid route of delivery with the maximum plasma concentration achieved within 15 minutes of administration,” the study explained. “This pharmacokinetic advantage supports a potential role for timolol eyedrops in managing acute migraine.”

The research—a randomized, crossover, placebo-controlled pilot study—enrolled patients 18 years or older who met the International Headache Society criteria for migraine. The participants were randomized to receive timolol maleate (0.5%) or artificial tears, a single drop in both eyes, at onset and 30 minutes after. The patients were monitored over 4 months (5 visits total) and crossed over at the 2-month mark with a 3-day washout period.

The participants completed a data sheet to rate their migraine attacks on a scale of 0 to 3 in terms of severity. Also, at the end of the study, participants rated the effectiveness of each drop to determine whether they would use the timolol in place of or in addition to their current treatments.

There were 10 participants in the study and a total of 198 migraine attacks were assessed. According to the results, the overall effectiveness of timolol was 2.4 compared with 1.4 with the placebo.

Additionally, 4 participants reported that timolol was highly effective compared with placebo. However, 1 patient experienced the opposite effect. Thirty-seven of 55 migraines were found to have a severity of none or mild at 2 hours while using the timolol treatment, compared to 58 of 77 with the placebo.

“One participant developed a branch retinal artery occlusion while using placebo, which was believed to be unrelated to the study,” the study stated. “No other adverse events, including hypotension or bradycardia, were observed.”

The authors emphasized that although this pilot study successfully explored the efficacy of timolol eyedrops, further research is necessary to identify patients who would benefit the most from this treatment and an appropriate dosage.

“Several participants responded extremely well to the timolol,” the study concluded. “Further research is needed to determine what patient factors might predict responsiveness to timolol.”

Cossack M, Nabrinsky E, Turner H, Abraham A, Gratton S. Timolol eyedrops in the treatment of acute migraine attacks: a randomized crossover study [published online May 14, 2018]. JAMA Neurol. doi: 10.1001/jamaneurol.2018.0970.
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