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Beta-Blocker — Migraine Prophylaxis

Propranolol (Migraine Prevention)

Brand names: Inderal, Half-Inderal LA

Used in: Headache & Migraine

This entry covers propranolol, a non-selective beta-blocker, used as a first-line oral preventive treatment for migraine.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Its migraine-prophylactic benefit is not fully defined but is attributed to central and vascular beta-adrenergic blockade that reduces neuronal and vascular excitability.

Prescribing in practice

  • It is contraindicated in asthma and should be used cautiously in other reversible airways disease because non-selective beta-blockade can provoke bronchospasm.
  • Avoid in uncontrolled heart failure, significant bradycardia or heart block, and use with care in diabetes as it may mask hypoglycaemia.
  • Do not stop abruptly, as withdrawal can cause rebound and beta-blockers should be tapered.

Monitoring

Monitor heart rate, blood pressure, headache frequency and tolerability, with attention to fatigue, mood and respiratory symptoms.

Counselling the patient

  • Take regularly for prevention; it does not relieve an acute migraine attack.
  • Do not stop suddenly, and report wheeze, marked tiredness or a very slow pulse.
  • Allow several weeks to judge whether attack frequency improves.

Evidence & guidelines

NICE recommends propranolol as a first-line option for the prophylaxis of migraine.

Reference: NICE NG218 (Migraine); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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