Timolol eyedrops may help with management of acute migraine attacks

Timolol maleate ophthalmic solution, 0.5% should be considered in the management of acute migraine attacks, according to a study in JAMA Ophthalmology.

In this randomized, masked placebo-controlled crossover trial, 50 patients with migraine were randomized to receive either timolol eyedrops or a placebo eyedrop (carboxymethyl cellulose, 0.5%). Patients were instructed to put a drop in each eye at the onset of a migraine. After randomization, 7 patients (14%) withdrew.

Patients used the original treatment for 3 months, underwent a 1-month washout period, and then received the opposite treatment for 3 months.

In total, 619 migraines occurred during the study period; 284 (46%) were treated with timolol, 271 (44%) were treated with the placebo, and 64 (10%) occurred during the washout period.

More patients treated with timolol eyes drops had a reduction in pain score by 4 points, or to 0, 20 minutes after administering them than those using the placebo-treatment (82% vs 14%, respectively).

At 20 minutes, the reduction in pain score was greater in the participants treated with timolol compared with those treated with placebo by a mean (SE) of 4.63 points (0.34) (P <  0.001).

The authors note that longer follow-up with larger groups are needed.

Reference

Kurian A, Reghunadhan I, Thilak P, Soman I, Nair U. Short-term efficacy and safety of topical β-Blockers (timolol maleate ophthalmic solution, 0.5%) in acute migraine: A randomized crossover trial. JAMA Ophthalmol. 2020; doi:10.1001/jamaophthalmol.2020.3676