A beta blocker eye drop that costs less than $10 may be able to help acute migraine sufferers by stopping the acute attacks from worsening or at least lessening their intensity, according to several ophthalmologists.
The doctors find that timolol eye drops (0.5 percent) that are approved for a certain eye disorder, when used off-label, are an effective and relatively safe treatment for patients with acute migraine when used immediately after symptom onset.
Dr. John C. Hagan, an ophthalmologist with over 50 years of experience said that for some people, treating their acute migraines involves using timolol in combination with other medications.
“So most of the people that we call success, don’t use the beta blocker drops as sole therapy,” Hagan told The Epoch Times. “They use like an analgesic, Tylenol or aspirin, or they use a non-steroidal anti-inflammatory like Advil or something like that.”
Dr. Melissa Toyos, an oculofacial plastic surgeon who developed migraines in her late 20s, relies on several different medications to abort the acute migraine attacks.
“I have access to all of the migraine meds including many of the pricier ones and ironically, the triptans have caused chest pain and minimal improvements while otc [over-the-counter] Excedrin and beta blockers (along with CGRP inhibitors and anti-nausea sublingual tablets) have become my mainstay,” Toyos said in an email to The Epoch Times.
She said that the beta blocker eye drops help with “nipping the migraine in the bud before it becomes full-blown and avoiding some of the less desirable side effects of other headache medications.”
“When doctors prescribe beta blockers in pill forms for heart palpitation [patients], many of them reported that their migraines got better,” Hagan said.
Eureka Moment
In 1978, a liquid form of a beta blocker, timolol eye drop, was approved by the FDA (pdf) to treat glaucoma, an eye disease that can lead to vision loss.Patients who were being treated for glaucoma reported that their “migraines got better when they were putting their beta-blocker eye drops in every day,” Hagan said.
In 2013, Hagan’s colleague, a glaucoma specialist, shared his clinical experiences using timolol eye drops for treatment of acute migraines and suggested Hagan’s daughters, who had developed migraines in their 30s, try the medication as soon as symptoms of a migraine began.
The conversation sparked an interest in Hagan who wanted to know why the eye drops were effective for acute migraine but pills weren’t. Hagan dove into the literature and the limited studies on beta blocker eye drops, and after many hours of poring through the data and discussions, he and his colleague experienced a eureka moment.
“Then, it sort of dawned on us. It didn’t take that long [to realize] that if you take a pill, a migraine pill, it has to go through the stomach, be digested, and then go through the liver where some of it’s drained off,” Hagan said. “It takes a long, long time to get a therapeutic level, if a therapeutic level is reached at all.”
“And that was why it doesn’t work [for acute migraine] when it’s taken in pill form.”
Struggle to Get FDA Approval
Hagan and his colleague, for the past eight years, have reached out to academic institutions and more than 50 drug manufacturers who have the capacity to develop and fund a phase 3 randomized trial to demonstrate and confirm that timolol is effective, safe, and beneficial for acute migraine. A large clinical trial is needed prior to applying for FDA approval.While timolol eye drops may be used off-label for acute migraine, doctors may still be put off from prescribing it due to lack of information regarding how to best use it outside of what it’s approved for. But that may be remedied if the FDA approves it for a new indication, such as acute migraine, as all the necessary information will be available to help the physician make a decision.
The responses from pharmaceuticals were not what Hagan had expected, with many initially expressing interest but later rejecting their proposal.
Without profit to make, neuro-ophthalmologist Dr. Bradley Katz said, pharmaceuticals won’t fund the study.
Off-Label Use
Off-label use is when a drug is used for any other medical condition, or given in a different manner or dose than what it’s federally approved for.A nasal spray would be the “easiest, fastest, and most effective way to deliver” the medication and it would also help people who have difficulty properly using the eye drops, Hagan said.
Katz has been using the beta blocker eye drop to treat his own migraines and also prescribing it to patients. He advises that acute migraine sufferers discuss with their doctor if they should try timolol.
“They can just pop in a couple of drops, wait 20 minutes. If they’re not getting better, they can put in another set of drops. And if it works, great, and if it doesn’t work, well then you haven’t really lost anything,” he added.
While relatively safe to use, timolol can cause some common side effects such as dry eyes, burning in the eye, or red eyelids. Timolol is not recommended for people with conditions like asthma, emphysema, or an irregular heartbeat, according to Katz. There is concern that the medication may worsen their condition.
In addition, people who’ve had a negative reaction to beta blockers should avoid this medication, according to Hagan.
Lanette Todd, an ophthalmic technician, has used timolol eye drops off-label for more than seven years without any issue although she has asthma.
“I don’t have any underlying issues, so it was never a problem for me,” Todd told The Epoch Times.
Todd was diagnosed 18 years ago with ocular migraine that causes temporary vision problems in one eye that lasts for about an hour.
Prior to using timolol eye drops, Todd said she took an aspirin and caffeine and “just wait it out.”
She said taking the eye drop sublingually, or underneath her tongue, provided quicker relief than as eye drops.
“So I started out putting them in my eye, like one drop in each eye, and it helped a little bit,” Todd said. “Then we discovered if you put it under your tongue, put the drops in, then it would go to your system faster, kind of get in your bloodstream a lot faster through your saliva.”
Todd’s teenage daughter and sister also suffer from migraines and the beta blocker eye drops have helped with the acute attacks.
Carolyn Csongradi has suffered from migraines for over 40 years and said the eye drops were very effective in treating her acute attacks. But she’s had to discontinue the medication because of the sinus congestion she experienced as a side effect.
Prevalence and Characteristics
One in five women live with migraines, whereas one in 16 men experience them.
Katz said that children with migraines don’t necessarily experience headaches like adults.
“In kids sometimes they don’t get headaches as much as they get car sickness,” Katz said. “So, a lot of people who have migraines as adults are carsick as children.”
He added that some children who get stomach cramps or stomach pain for no apparent reason may be a “pediatric manifestation of migraine.”
Migraine is considered a chronic, debilitating condition where headaches are only one of its symptoms that can last for a few hours to several days. Other accompanying symptoms may include extreme sensitivity to light and sound, nausea, and vomiting. Some people also see an aura that occurs prior to or with a headache.
Federally Approved Drugs
Several newer drugs for acute migraine have been approved in the past several years.Toyos said she has “tried almost everything for migraine” and knows how important it is for patients to have access to all the medications that will help treat their acute migraine.
“I think what is important in this story is that our healthcare system can sometimes be oriented to the latest and greatest and good, solid, older medications might be overlooked in the market due to smaller profit margins,” she said.
“When those medications are effective, both patients and our healthcare system benefit. It is important for migraine sufferers to have access to all medications that are useful so that they, too, can get back to their busy lives and remain productive even while living with migraine.”