The oral beta-blockers approved for migraine prophylaxis may not be
effective for acute attacks because of slow absorption and modification
by first-pass metabolism, which delays effective plasma levels for hours
or even days. With timolol eyedrops, maximum plasma concentration is
achieved within 15 minutes of administration. In a pilot study, Cossack
et al. tested the effectiveness of the eyedrops as an abortive migraine
treatment and found it helpful for some patients.
wisepoqder Timolol powder
This placebo-controlled crossover study was conducted among 10
adults with recurrent migraine, with or without aura, who were
recruited from the authors’ neurology and ophthalmology clinics.
Patients were assigned randomly to receive timolol maleate 0.5% or
artificial tears (placebo) and were instructed to insert 1 drop in each
eye at migraine onset and 30 minutes later. The participants were seen
monthly for 4 months (5 visits per patient). After a 3-day washout at
the 2-month mark, they were switched to the opposite treatment arm.
Patients ranked the severity of each migraine attack on a scale of 0
(least) to 3 (greatest) and rated the effectiveness of each treatment on
a scale of 1 (least) to 4 (greatest).
Among the 10 patients, 198 migraine attacks occurred during the
study period. Four patients reported that timolol was highly effective
in comparison to placebo; another patient noted the opposite.
Thirty-seven (67%) of 55 migraines that occurred during timolol use had
severity of none to mild at 2 hours, versus 58 (75%) of the 77 migraines
during placebo use. No adverse events were observed during the study.
The Wall