Timolol as a migraine acute attack therapy: randomized, OTCs control study

Background: Migraine is manifested by recurrent headache attacks, with variable characteristics and associated symptoms. Oral beta-blockers are widely used to prevent and reduce the frequency of these attacks. However, the use of topical beta-blockers for acute treatment is still controversial. Aims: In this randomized double-armed study, we aim to compare the efficacy of timolol 0.5% eye drops compared with other over-the-counter (OTC) medications used for the acute treatment of migraine. Patients and methods: Fifty-seven patients were randomly allocated to group A (treatment group: timolol 0.5% eye drops) and group B (control group: OTC drugs including NSAIDs, caffeine, aspirin, and acetaminophen). The primary outcome was pain reduction. Secondary outcome measures included reducing nausea, vomiting, photophobia, and phonophobia. Results: Median pain reduction for the OTC group was higher than for timolol (6, 4 prospectively) with a significant U test (P < 0.001). We found a significant correlation between pain severity and degree of pain reduction (r 1⁄4 0.480, P < 0.001). Twenty-six (89.6%) patients in the control group compared with eight (28.6%) patients in the timolol group reported pain reduction by 5 or more. Both timolol and OTC were effective on headache associations: nausea, photophobia, and phonophobia. Conclusion: Both timolol and OTC are equally effective in acute migraine attacks. But OTC drugs are still preferred due to their superior abortion effect.