propranolol inderal dosage for migraine and headaches

Migraine headache medication. Migraine prevention with Inderal (Propranolol)

Migraine headache medication. Migraine prevention with Inderal (Propranolol)

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Dr. Brigitte Mueller-Morel, MDDr. Brigitte Mueller-Morel, MD


What causes migraines?

Migraine is an acute disease characterized by the severe and intensive headache. The attacks of the headache during migraine are painful, so that a human cannot do anything and experiences moral and physical sufferings.

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Migraine is considered a neurological disorder, and headache appears as a result of the dysfunction of the blood vessels. The clinical studies have detected the essential causes of the migraine development, and genetic factors play an important role. The scientists have even distinguished a range of genes that increase a risk of the development of migraine.

The organic factors also favor a development of the migraine:

  • Stress, overfatigue;
  • Nervous and physical tension;
  • Consumption of certain food (for example, dark chocolate, cocoa, cheese);
  • Lack of sleep;
  • A sudden flash into the human eyes;

As of today, it is impossible to explain the pathophysiological process that happens in the brain during the migraine outbreak. Therefore, doctors still wonder about the real causes of this pathology.

In general, scientists have three options of the migraine occurrence:

  • Migraine appears as a result of the narrowing of the blood vessels in the brain, and it causes an edema of the tissues leading to a severe headache.
  • A metabolism disorder happens in the tissues of the brain, and it causes the intravascular changes related to the disorder of the serotonin metabolism.
  • Migraine appears as a result of the neurovascular disorders of the central nervous system, and it serves as a trigger for the activation of the vasomotor regulations.

If we consider this problem in the practical point of view, it is clear that the migraine appears as a result of any pathological processes in the blood vessels of the brain, and it affects the nutrition with the oxygen, causes edema, and reversible changes in the motions of the neurotransmitters.

Migraine headache symptoms

Migraine is an acute type of the neurological disease, the symptoms of which appear only during the attack. The symptoms of the disease may differ in various patients. The main sign of the disease is a severe headache occurring in any part of the head on one side. A duration of the attack may take 4 to 72 hours.

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Besides the main symptoms of the migraine, there are concomitant signs of the pathology development:

  • Nausea;
  • High sensitivity to light and noise;
  • Poor concentration;
  • Excess sweat;
  • Body temperature swings (fever or shivers).

252 800 people with migraine took part in the largescale study, and it was detected that the attack was accompanied by prodrome in 60% of cases.

A prodrome is one of the symptoms that precedes the attack of the migraine. The migraine with prodrome begins from a flash or unknown optic outbursts, a narrow field of vision, tingling or numbness in the extremities, and even difficult speaking.

The practice shows that the migraine with prodrome has its own drawbacks and advantages. One of the advantages is that a patient can take preventive measures. The migraine without prodrome is hardly detected because it begins all of a sudden, and it is very important to take medications as soon as possible to treat the migraine.

Types of headaches

Headache appears not only because of the migraine. It is the most common symptom of the pathological changes in the body, or a kind of the body reaction to the action of the irritator. If the headache appeared, do not think that the pain occurs in the nervous tissues of the brain because they do not have painful receptors. The pain occurs in certain areas in the head and neck. Depending on the area of the started headache, it is possible to detect its type and a cause.

types of migraine headaches

Doctors distinguish 6 main types of the headache:

  • The vascular headache is caused by the disorders in the work of the blood vessels of the brain. This type includes migraine.
  • Headache because of the muscle tension: pain starts in the cervical spine and activates the painful receptors in other parts of the head.
  • Neuralgia: headache occurs as a result of the irritation of the nervous system.
  • Psychogenic headache: a somatic symptom of the psychological disorder. This is the frequent symptom in patients with depression or schizophrenia, when any physiological causes of pain are absent.
  • Headache of liquor dynamic nature: pain occurs because of the changes of the intracranial pressure.
  • Sinus/infectious headache appears as a result of the infection of the subcortical structure of the brain, or as a result of the infection of the sinuses and an edema of the mucous membrane in the area of the nose, and eyes.

In general, the headache is classified by not only the nature, but also by the severity, duration, and others. But these 6 types are essential during placing a diagnosis and detecting the method of the treatment.

How to prevent migraines? Migraine prevention medications

It has been argued that it is impossible to prevent the migraine, and the preventive measures are pointless. It is true in some way. But none specialist can predict a development of the migraine outbreak, and as there are no exact causes of this pathology, the methods of the prevention of this pathophysiological process are absent. However, the scientists have managed to detect the properties of the beta blockers and found out that their application may give a positive reaction to prevent migraine.

what to take for migraine

The matter it that migraine belongs to the vascular type of the headache, and it means that the blood vessels of the brain are essential in the pathophysiological process. The most effective way to prevent the migraine is a use of medications affecting the beta adrenoceptors. Why this group of medications?

The matter is that the blockers of the beta adrenoceptors have a hypotensive action, improve the tone of the blood vessel walls, regulate the blood circulation and have a wide therapeutic action. The efficiency of the beta-adrenoceptors in the prevention of the migraine has been proved in the American National Institute of Neurological Disorders and Stroke (NINDS). The studies have shown that the beta-adrenoceptors are the only class of the drugs that are effective in the prevention of the migraine, not in the treatment of the disease symptoms. They act on an ultimate cause of the pathological process, not on the physiology of the disease.

As to the non-medicamental methods to prevent the migraine, patients with frequent attacks are recommended to:

  • Follow sleep regimen (not more than 9-10 hours a day, and not less than 6 hours a day);
  • Learn to control emotions and avoid stress;
  • Avoid coffee, green tea, black chocolate, nuts, flavor intensifiers, alcohol, and cigarettes;
  • Spend time out of doors and do breathing exercises for better oxygen nutrition.

How does Propranolol (Inderal) prevent migraines?

The excessive dilation of the blood vessels of the brain happens during the migraine outbreak, it causes an edema of the tissues. Propranolol as one of the strongest beta-blockers is able to control the tone of the vascular walls preventing the excessive dilation. So, a degree of the brain tissue edema will be lower as well as the migraine symptoms.

best migraine medication Propranolol

Dr. Brigitte Mueller-Morel, MDDr. Brigitte Mueller-Morel, MD: Moreover, taking Propranolol, the blood flow is regulated in the blood vessels, and it gives an additional effect during the prevention of the migraine. The blood vessels work well, and so a risk of the blood circulation disorder is minimal. It has been proved that the use of Propranolol to prevent the migraine reduces the frequency of the migraine outbreaks by 26%.

There is data stating about the antagonistic properties of Propranolol as to serotonin receptors type 5НТ2. It is considered that these receptors play an important role in the formation of the migraine attack. Moreover, Propranolol reduces a risk of the migraine and a need of a person in the analgesics. In case of the preventive treatment, the headache during the attack is less intensive and passes faster.

Propranolol (Inderal) dosage for migraine prevention

A dosing of Propranolol (Inderal) for the prophylaxis of the migraine depends on the frequency of the attacks and their intensity. In case of the light type of the disease, Propranolol (Inderal) is taken in the dose of 20 mg 2 times a day with the interval not less than 8 hours. The drug may be taken for a long period for the permanent control of the vascular reaction.

best migraine treatment - Propranolol

If the migraine outbreaks appear every day, or even more, the dose of Propranolol (Inderal) is gradually increased up to 160 mg a day (a tablet of Propranolol (Inderal) 40 mg 4 times a day, or a tablet of Propranolol 80 mg 2 times a day). This high dose will let better control the vascular activity but will increase a risk of the side effects.

As soon as a patient lowers the frequency of the migraine attacks, the dose of Propranolol (Inderal) should be lowered. A patient should know that taking Propranolol (Inderal) in the dose of 160 mg a day, there is a risk of the severe drop of the blood pressure and a reduction of the heart beats (bradycardia). In case of these symptoms, the dose of the drug must be lowered, or refuse from the use of the drug for a while.

Best time to take Propranolol for migraines

The migraine outbreak may last for more than 2 days and begin all of a sudden, even in your sleep. So, there are no certain recommendations including the dosing regimen of Propranolol. It is better to take Propranolol in the morning before or during breakfast. If you take the tablets 2-3 times a day, divide the daily dose equally and take it with similar interval – 8-10 hours.

Some physicians state that the extended-release capsules Propranolol should be taken one hour before sleeping. However, the clinical confirmations of this regimen are absent.

Every patient should find the most convenient period to take Propranolol at the same time, and follow the regimen. Bear in mind that a stable control of the migraine is achieved only during the regular use of Propranolol.

Diet for migraine headaches. Best food for migraine relief

There are evidences that diet directly influences on the frequency of the migraine outbreaks. Some food or drinks cause a change of the blood pressure, may activate the serotonin receptors, and others. Moreover, a cause of the headache may be amines, ingredients that are formed out of the amino acids naturally or under the influence of bacteria during the use of certain products. For instance, histamine is a product of such biological process.

Dr. Brigitte Mueller-Morel, MDDr. Brigitte Mueller-Morel, MD: But most doctors still cannot realize a connection between the pathophysiological process in the blood vessels of the brain and food. In spite of this, following certain principles of nutrition, a patient can reduce the frequency of the outbreaks and relieve their course.

The main rules of diet during migraine:

  • Do not go hungry. A hunger may cause the outbreak.
  • Avoid food glut, do not go in fatty, salty, sweet and pickled food.
  • Do not go in alcohol, especially beer, red wine, and champagne.
  • Do not experiment with the exotic meals. You do not know how your body will react to a change of the nutrition.

What products do help to reduce the migraine and a severe headache?

  • Vegetable oils: olive, grape, sesame, flaxseed.
  • Fresh low-fat fish, especially sea fish.
  • Low-fat milk products (cream will not do).
  • Boiled vegetable, chicken.
  • Fresh seasonal fruit and vegetable, and organic juices.

It is also recommended to consume riboflavin (vitamin B2) that protects the cells of the brain against oxidizing affection, conduces a digestion of iron, zinc, and folic acid. Broccoli and low-fat beef contains a lot of riboflavin.

Food should be light, simple and rich in vitamins. Avoid a consumption of caffeine, sugar, and nitrates. Use vegetables during the outbreak. It will relieve the headache and help to cope with nausea that may occur during the migraine. The main rule is do not starve and do not overeat. Meals should be soft and contain at least 1200 kcal a day.

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