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American Board Certified Neurologist, Internal Medicine
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hi....my doctor prescribed atenolol 25mg to see if it would
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hi....my doctor prescribed atenolol 25mg to see if it would help with migraines....is this a drug usually prescribed for them? the primary said he felt comfortable prescribing it until i get seen by neurology which won't be for a few months...is atenolol effective for migraines? how long before it works if it is going to? what is the maximum dose? he said there are other blood pressure drugs that can be used but he said atenolol had the least side effects...also, can it be taken before bed? or is am better?.....also, is lyrica effective for migraines? or is neurontin better?....and how long before either of those would work if going to and what dose is best with them for migraines?.....thank you for your answers.
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replied 3 years ago.
Hi, this is Neuro Doctor and I am very glad to help you with your question.
Yes, atenolol is very effective for the management of migraine prevention and it is commonly used for this purpose. Atenolol belongs to a group of meds called as beta blockers (also used to control blood pressure) and there are few other similar meds in this group called as propranolol, metoprolol etc and any of them can be used for migraine prevention and atenolol may produce less side effect compared to other beta blockers like propranolol so it is an advantage. Atenolol can be taken at any time of the day including the bed time or the am time. And it is long acting so once daily dose is sufficient. It is started usually at 25 mg per day and then slowly the dose can be increased up to the maximum of 100 mg per day. Lyrica and Neurontin are also used for migraine prevention and both are similarly effective in this regard, and side effect wise lyrica may produce somewhat less sedation otherwise there is no other major difference between these two meds. The dose range on lyrica for migraine management ranges from 50 mg to 600 mg/day in divided doses and on Neurontin the dose range is 300 mg to around 3000 mg/day in divided doses. And all these migraine prevention meds may take some time before they become effective, usually at least a week’s time is needed and sometimes it may take longer (few weeks), the smallest dose is tried first and then slowly the dose is increased as necessary and as tolerated.
I am not sure what else you have tried for the management of the migraine, what I will do is provide you with a list of different options to consider (if ever needed in the future);
1) Treatment options for acute migraine attacks;
Anti Inflammatory agents like Tylenol, Naproxen, Ibuprofen
Gelstat sublingual (feverfew + ginger extract)
Triptan agents like Sumatriptan, Rizatriptan, Naratriptan, Frovatriptan etc (some of them have all 3 forms including oral tablets, nasal sprays & self home injections)
Triptan agent + Anti-inflammatory pain killer combination like Tab Treximet
Cap Midrin (arranged through compounding pharmacies)
Ergotamine preparations (tablets, suppositories, nasal inhalers, home injections etc)
2) Treatment options to help in preventing the future migraine (migraine preventive treatment options):
Beta blockers like Tab Atenolol, propranolol, Metoprolol (discussed above)
Anticonvulsants like Tab Topiramate, Depakote, Keppra, Zonisamide, Neurontin, Lyrica (some of these discussed above)
Tricyclic medications like Amitriptyline, Nortriptyline
Calcium Channel Blockers like Tab Verapamil, Diltiazem
Botox injections etc
3) Non-medication treatment options for migraine prevention;
Trigeminal nerve Neurostimulation with Cefaly (a medical devise)
Occipital nerve block
Occipital Nerve Stimulation
TENS (Transcutaneous Electrical Nerve Stimulation) etc
You may not need all these above treatments, I am just providing you with a list like this so that you are familiar with the different available options. Obviously you may try now atenolol, and the above other options are needed only if atenolol is not helpful, not otherwise.
Another point I wanted to discuss is about the migraine triggers; you might be already aware that there are several migraine triggers that can also precipitate migraine attacks. If not done already then try to identify these triggers and avoiding triggers itself may help enormously in some patients and reduce the severity & frequency of migraine attacks and also reduce the dependence for any migraine medications.
The following are examples of migraine triggers;
Varieties of food stuff (cheese, chocolate, ice creams, certain mushrooms etc), food-preservatives (MSG, nitrates etc), caffeine, chemicals such as perfumes, cleaning agents, cigarette smoke, stress, sleep deprivation, food deprivation (hypoglycemia or low blood sugar), weather changes, certain odors, hormonal, alcohol especially red wine etc; and for different people the triggers may be different.
If you identify any of the above as a migraine trigger in your case try to avoid it as much as possible and as pointed above avoiding the triggers itself can significantly help in controlling the migraine attack and reduce the need for the migraine medications.
Once again, yes atenolol is good for migraine prevention and it is commonly used for this purpose. Lyrica and Neurontin are some other options and there are many other options as pointed above (if you ever need other options in the future), and also if not already done then also try to identify and avoid the migraine triggers as much as possible and it will help in reducing the need for the meds.
Please let me know if you have more questions. And if you feel you have received the information you are looking for rate me “Excellent” to compensate me for the time and effort put by me in answering your question.
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