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Beta-blocker eye drops may alleviate migraine pain

JAMA Ophthalmology
Reuters Health - 02/10/2020 - Eye drops containing the beta-blocker timolol alleviate head pain in the majority of migraine attacks, a small trial finds. In the randomized, masked placebo-controlled crossover trial involving 50 patients, pain levels were reduced at 20 minutes by four points, or to zero, in 233 migraines (82%) treated with the eye drops compared with 38 (14%) of the placebo-treated attacks, researchers report in JAMA Ophthalmology. "The factor precluding the use of oral beta-blockers in acute migraine attacks is proposed to be its high first-pass metabolism and time taken to achieve peak plasma levels," the researchers, led by Dr. Abraham Kurian of the Chaithanya Eye Hospital and Research Institute, write. "Unlike oral administration, ophthalmically administered beta-blockers bypass first-pass metabolism by the liver. Because the pharmacokinetics of nasopharyngeal absorption may be similar to those of an intravenous bolus, plasma levels are achieved ...

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