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Glaucoma Treatment
Beta-Blocker Drops for Acute Migraines?

Relief may require only a $4 generic.

Acute migraine headaches may be stopped or often reduced in intensity with beta blocker eye drops, the widely available glaucoma medication that costs as little as $4 per bottle, according to John C. Hagan III, MD and Carl V. Migliazzo, MD, both of Kansas City, Mo. The pair have published a study of seven acute migraines patients treated over a multi-year period.1 While the daily use of beta blocker pills has proved effective in preventing chronic migraine headaches, they have been unsuccessful in treating acute, sudden-onset migraines. Beta-blocker eye drops, however, are absorbed more quickly than pills by tear duct drainage onto the nasal mucosa, the investigators say, achieving therapeutic plasma levels “within minutes.”

Drs. Hagan and Migliazzo note that their study is small, selective and retrospective — all seven of the case studies involved female patients, for instance — and as their peer reviewers pointed out, controlled prospective studies are needed. The University of Kansas

Medical Center, Kansas City, plans to launch its own prospective study and has invited Drs. Hagan and Migliazzo to be part of the protocol development.

While the findings are exciting, Dr. Hagan notes that developing a commercial product may be problematic. “Big pharma has some interest in trying to develop a commercial product,” he says. “But obviously, there is no way a company could justify the investment required to get an FDA-approved indication for an eye drop that’s available for $4. There would have to be some sort of unique delivery system that would be patentable.” Dr. Hagan points out physicians who want to try the treatment using generic beta blocker eye drops should read the study and inform the patient of its’ off-label use. “They could do that today.”