Normally I don’t discuss medications on this site, but on this World Brain Day which features the painful truth about Migraine, I wanted to share my very personal experience with timolol drops for migraine in case it may help others. I have been using timolol malate ophthalmic solution for the past three years as both a vestibular migraine preventive and, most recently, as an acute treatment.
When my doctor first prescribed this (like any curious patient) I took to the internet to search through everything I could about it. I checked all my migraine support groups, yet I could find nothing on timolol for migraines. It seemed like I was the only person in the world on this particular medication. Beta blockers in pill form, like propranolol, have been used for years to treat migraine disorders, yet this was a method that seemed to be rarely used.
At my next appointment with Dr. Beh, I asked him why he recommended it to me. He mentioned that there’s a tendency for beta blockers to have greater side effects when in pill form, but as an eye drop it can be absorbed quickly into the blood stream, making a very small amount of medication highly effective. Used in this form, I could have faster relief but with lowered risk of side effects.
Timolol for Migraines
So why did it feel like I was the only person in the world on it? First of all there wasn’t a ton of research on it, even though the research out there is positive, so a lot of the successful feedback came from Dr. Beh’s own patients.
The other reason? Money. Pharmaceutical companies don’t really want to invest in a drug that they cannot market. There’s more money involved with all the new anti-CGRP treatments and Botox, which means more research. For a generic eye drop, it’s not going to get a lot of attention or money invested into it. (If you check out this study, don’t miss all the ads for anti-CGRP or Botox that surround it and you’ll see what I mean.)
The Research for Timolol Malate
In studies, timolol has been found to be just as effective as propranolol in migraine prevention at 20-30mg a day. Yet with the oral dosage of beta blockers being the most popular prescription, it absorbs too slowly to be considered an acute treatment. Timolol received FDA approval in 1978 for the treatment of glaucoma, and when used as eye drops, patients would report the added benefit of a reduction in migraine attacks.
Ophthalmologists Hagen and Migliazzo put these observations together and published a study in 2014 in The Journal of the Missouri State Medical Association. Five out of their seven patients reported complete pain relief, while the other two reported a significant reduction in pain relief when used in their acute migraine attacks.
In 2018, a study of patients who met the International Headache Society’s requirements for migraine received timolol maleate eye drops in 0.5% dosage, a single drop in each eye, at the onset of symptoms and once again 30 minutes after. The study took place over a 4 month period, where ten patients scaled their pain from 0 to 3, and rated the effectiveness of the drops when used for their attacks. Timolol was rated at a 2.4 in effectiveness when the placebo was rated at 1.4.
Four of the patients rated this treatment as highly effective and only one had an adverse reaction to the treatment. Of all the migraine attacks reported, 37 out of 55 had no symptoms to mild symptoms when the timolol treatment was used early.
Side Effects of Timolol Drops for Migraine
The current medications used in acute treatments, like NSAID’s and triptans, come with a risk of rebound attacks when used too often. Since beta blockers are already used as a daily migraine preventative treatment, it’s likely they wouldn’t carry that same risk.
Side effects of traditional beta blockers can include lower blood pressure or an adverse effect on asthma. However, the dosages in pill forms are much higher than what can be taken in the eye drop form, meaning there would be a lowered risk of these potential side effects. Also, if taken as an abortive and not a preventative medication, some with low blood pressure find they can tolerate it well.
Since these drops are used often for glaucoma, it should come with little to no risk to the eyes, however a meeting with an ophthalmologist is always essential. In the beginning, I found the drops stung for a few seconds when first applied, yet it quickly went away.
Personal Experiences with Timolol for Migraine Treatment
I was prescribed the 0.5% solution with instructions to take it 2x a day, at night and in the morning. Then I could use it as needed for bad attacks. It did take a while for me to notice a reduction in symptoms, a couple of months at least. However, I was not the kind of patient who expected results overnight. I stayed the course and kept doing what I was supposed to. I think what helped me the most was combining these drops with other preventative measures, like the diet and supplements.
Now that my vestibular migraine is fairly well controlled, I use the timolol eye drops as an abortive or rescue medication. Just a drop in each eye when I feel my dizziness kick up seems to help ease my head a bit and lessen an attack. I find this is also true for my other friends with head pain associated with their migraine.
Eileen and Marina from Migraine Strong have been using them recently with a lot of success, especially when coupled with other abortive measures like ginger. Eileen says “I am excited to have the option of using Timolol because I haven’t had a true abortive medication since my migrainous stroke in 2014. Timolol works to abort my attacks about 80+% of the time, including brain stem attacks. And it hasn’t affected my low blood pressure which was a concern for my headache specialist when he prescribed it. I am super happy with Timolol as an acute medication.”
Talking to Your Neurologist about Timolol Drops
If you’re curious to try this treatment, I recommend printing out all the studies and approaching your neurologist about it. The feedback I typically hear is that they have either never heard of this, or the trials weren’t large enough to prove anything significant. While that might be true, there are lots of treatments when it comes to migraine, especially vestibular migraine, that aren’t backed by massive studies. I feel that it’s these small, yet very positive, studies that can make a huge difference in some of our lives. It certainly did for me!
For more information on Migraine management, see these posts:
Natural Migraine Treatments
Vestibular Migraine Symptom Guide
Vestibular Migraine Diet
Heal Your Headache Migraine Diet
Best Types of Magnesium for Migraine
My Vestibular Migraine Story
The VM Guide for Dummies
Referenced materials:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312165/
2. https://jamanetwork.com/journals/jamaneurology/article-abstract/2680666
3. https://headaches.org/2016/07/01/use-beta-blocker-ophthalmic-solution-treatment-migraine/
4. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/neurology/headache-syndromes/
5. https://www.ncbi.nlm.nih.gov/pubmed/2879629
6. https://www.neurologylive.com/clinical-focus/timolol-migraine-shows-efficacy-abortive-therapy
Asking my HAS about these this week!
Bring some of these studies with you!
Thank you Alicia! I will do some follow up study and consider.
Hi Alicia, Thank you for all the very helpful info! I actually remember reading about Timolol a couple years ago, I brought it up to my neurologist but she just seemed confused and directed me to propranolol. I didn’t know enough about Timolol at the time so I didn’t press the subject. I was excited to read it’s been effective for you! I plan to follow up with my doctor about it tomorrow. I’m really trying to get off the Naproxen/Naratriptan roller coaster. On a separate note, have you read about Topical Bimatoprost in the treatment of migraine? Bimatoprost is the same as Latisse, they’re amongst trials right now but they theorize brushing it on fingernails could be helpful for migraine prevention. I’m always hopeful for an answer to my migraines. Thank you again for all the great articles.
Melissa
I have not but that sounds super interesting! I’ll definitely be looking into it. I wish you such great success with trying to get out of that rebound cycle. So glad this could be a helpful option!
Hi Alicia! I’m only a two days into this journey and your website and IG has already been a huge support and blessing! Thank you so much!
I have talked with my neurologist at the University of Kansas Hospital and she said she was part of the trial that studied timolol drops and like you said, the results were not statistically significant enough to show a benefit… however she did tell me I could try it as an abortive but not at a twice daily preventative. I am still in my 24/7 cycle of dizziness so I was hoping to be able to try what you did. She said she was open to any other literature and articles that suggested it to be helpful on a daily basis… Have you seen anything like this? Or how did your doctor come to the conclusion to have you on it daily?
Thanks again for you support and your time!!
Hey Emily, Timolol is a very common migraine preventative with a lot of research behind it so I’m not sure if she’s looking for research on the drops specifically? There is no research for the drops specifically as a preventative (the post gives a clue why this may be). Essentially it’s the same medication though. My neuro is at UTSW which is a research hospital so I believe they are more open to testing treatments out with patients who are willing. My appointments usually last about an hour and they take thorough notes on what’s working and what’s not for other patients. I was open to it because it was a lower dosage than the pill form and it seemed fairly easy to wean off of compared to other medications.
There are many different medications out there that help VM though so don’t feel like this is the only one that works. Dr Hain actually has a great chart on it. Timolol was just the best one for me since I couldn’t TTC on many of the other medications.
Same here. My doc gave as an abortive, not preventative. How long were you doing it daily for? How long before results? Thanks for your information on this!
I did it daily for about 2 years, I think? Somewhere around there. I probably saw results within 3 months but that was also combined with supplements and diet changes. Now that I’m not 24/7 chronic I can use them easily as an abortive. It works pretty fast!
February 2019 I had a sudden intense earache, strep throat, wheezing after attending a field trip with a friend who was coughing badly and later I found out she had the flu. I thought it was a virus so was treated at a clinic for that with antibiotics and steroids. When I got to my ENT he suggested VM but another doctor said it was a mastoid infection so treated me for that for months. I followed the diet anyway. I had constant dizziness, tinnitis, awful head and ear pressure and headaches. I was prescribed Noritriptyline or Elavil which is hard because I have RLS. Neurologists didn’t understand VM. One said I can try Aimovig so I did and not sure if that helped. I went off the diet and Elavil and was doing better but recently it came back so I am confused. I will ask about the eye drops. I feel so desperate for clarity on this. Thank you. Susanne
So sorry you’re struggling Susanne. It often takes a few different types of treatments and meds before we find the perfect one for us. I recommend reading Dr. Beh’s new book and sharing with your doctors as well.
Thank you for posting this and providing the resources to approach the neurologist. I’ve struggled with side effects of all the standard drugs and neurologist just gave me the go ahead to try this after sharing the papers you referenced. He had never heard of it, so I would have been out of luck without this.
So happy to hear this Chris. I do find a lot of doctors are more open to trying after seeing some of the research, even if it is small.