Beta Blockers Combined with Behavioral Management May Reduce Migraine Frequency in Adults

DynaMed Weekly Update - Volume 5, Issue 40

The American Academy of Neurology includes beta blockers in its guidelines for migraine prophylaxis (Neurology 2000 Sep 26;55(6):754). A recent randomized trial evaluating treatments for reducing the frequency of migraines evaluated beta blockers, a behavioral management program, and the combination of both interventions in 232 adult patients suffering at least 3 attacks per month. During a 5-week run-in period, all patients received acute migraine treatment that was individually optimized using triptans or selective serotonin receptor agonists, with NSAIDS, antiemetics, and steroids as needed. Patients were then randomized to 1 of 4 preventive groups: beta blockers only, beta blockers plus behavioral migraine management, placebo plus behavioral migraine management, or placebo only. The behavioral program included instruction in relaxation and stress management techniques and exercises for identifying migraine triggers. All patients continued their treatments for acute attacks throughout the 16 month trial.

At 10 months’ follow-up, the combination of beta blockers and behavioral management was associated with significantly greater reductions in migraine frequency than the other groups (level 2 [mid level] evidence). In the combination group, 77% of patients had ? 50% reduction in migraine frequency per 30-day period compared to 34%-40% for the other groups (p ? 0.001, NNT 3). The combination group had a mean reduction of 5.4 migraine days per 30-day period compared to a mean reduction of 3.3-3.9 days for the other groups (p < 0.0083). Results at the end of the trial at 16 months were similar to the 10-month results. Both groups that received behavioral management had significantly improved migraine-specific quality of life scores at 10 and 16 months (BMJ 2010 Sep 29;341:c4871).

Previous research has suggested that beta blockers alone may be effective for migraine prevention (Cochrane Library 2004 Issue 2:CD003225). In this trial, the placebo response rate was 40%, which was higher than the 30% found in the Cochrane review. As in previous trials, the dropout rate was high, with only 65% of the randomized patients evaluated at 10 months. The lack of significant differences between beta blockers alone and placebo in the current trial may be partly due to these factors.

For more information, see the Migraine prophylaxis - prescription medications topic in DynaMed.