Propranolol used to treat TMD and Migraines

In addition to being a comorbidity of TMJ Disorders (TMD), migraines are a common disabling condition.  Historically, about twice as many women suffer from migraines as men.  The temporomandibular joints have one of the body’s most prominent nerves running through it – the trigeminal nerve.  Both TMD pain and migraines are linked to the trigeminal nerve.  This nerve is responsible for transmitting pain, as well as commands for the orofacial muscles.  Because of the close proximity of this nerve to the jaw joints, if a person has underlying TMJ symptoms, the chance of facial pain is increased.  If the jaw joints are healthy and in their natural anatomical position, there should be no pain, inflammation or restricted blood flow.

photo of an xray showing TMD and migraines

There are different types of migraines, noted as follows:

  • Low-frequency episodic migraine: Up to 9 episodes per month
  • High-frequency episodic migraine: Between 10 – 14 episodes per month
  • Chronic migraine: 15+ episodes per month (With this condition, a person suffers from a “regular” headache on most days)

One drug that has been shown to be effective in the treatment of migraines is propranolol, which belongs to a group of medicines called beta blockers. Propranolol is the most commonly prescribed.  While it’s primary use is to treat heart problems, it also has been proven to help with anxiety and migraine prevention.

Propranolol is primarily used to:

Beta-blockers were first introduced in the late 1960’s and proved safe, inexpensive, and effective at treating heart conditions.  They were found to also help with migraine by accident. This happened when people who had been prescribed beta-blockers found that the drugs also alleviated their migraine symptoms.  They are generally effective and produce very little side effects overall.

photo showing how beta blockers prevent migraines

Across a wide range of thresholds, propranolol had greater efficacy in reducing TMD pain among migraine patients than non-migraine patients.  Studies have shown that positive response rates to propranolol treatment have ranged anywhere from 30-50%.  Propranolol can block sensitization of pain to the trigeminal nerve, which could be why TMD patients have a positive response in migraine reduction. Dosage amount and frequency varies from patient to patient.  If there are no positive results after 4-6 weeks, patients may stop taking it. The dosage is lowered over a period of time, as stopping too quickly can cause side effects.

The most common side effects include fatigue, dizziness, weight gain, cold hands/feet, and decreased libido.  Less common side effects include insomnia, depression and shortness of breath.  Beta blockers are not recommended for people with low blood pressure, diabetes and/or circulation problems. 

Propranolol reduces your heart’s workload and helps it beat more regularly.  

heartbeat symbol

It is believed that propranolol helps stabilize blood vessels in the brain. In addition, it may reduce anxiety, ultimately helping to decrease the frequency and severity of the migraines. Serotonin levels are elevated and activity in the hypothalamus increases with use.  Keeping a daily headache journal is recommended to monitor the efficacy.

woman grabbing her head because she has a headache

While more research must be done, many studies are showing that using propranolol can reduce the frequency and intensity of migraines by anywhere from 30-50%.  Regarding TMD patients suffering from headaches and migraines, this could be an extremely useful tool in the treatment and management of their chronic pain levels.

For more information on the treatment of TMJ disorders and the possible use of different medications in treatment, please contact our office at 586-573-0438.

References

  • Goncalves DA, Camparis CM, Speciali JG, Castanharo SM, Ujikawa LT, Lipton RB, Bigal ME. Treatment of comorbid migraine and temporomandibular disorders: a factorial, double-blind, randomized, placebo-controlled study. J Orofac Pain. 2013 Fall;27(4):325-35. doi: 10.11607/jop.1096. PMID: 24171182.
  • Light KC, Bragdon EE, Grewen KM, Brownley KA, Girdler SS, Maixner W. Adrenergic dysregulation and pain with and without acute beta-blockade in women with fibromyalgia and temporomandibular disorder. J Pain. 2009;10(5):542-552. doi:10.1016/j.jpain.2008.12.006
  • Tchivileva IE, Lim PF, Smith SB, et al. Effect of catechol-O-methyltransferase polymorphism on response to propranolol therapy in chronic musculoskeletal pain: a randomized, double-blind, placebo-controlled, crossover pilot study. Pharmacogenet Genomics. 2010;20(4):239-248. doi:10.1097/FPC.0b013e328337f9ab
  • Lim PF, Maixner W, Khan AA. Temporomandibular disorder and comorbid pain conditions. J Am Dent Assoc. 2011;142(12):1365-1367. doi:10.14219/jada.archive.2011.0137
  • Slade GD, Fillingim RB, Ohrbach R, Hadgraft H, Willis J, Arbes SJ Jr, Tchivileva IE. COMT Genotype and Efficacy of Propranolol for TMD Pain: A Randomized Trial. J Dent Res. 2021 Feb;100(2):163-170. doi: 10.1177/0022034520962733. Epub 2020 Oct 8. PMID: 33030089.
  • Zanelatto FB, Dias EV, Teixeira JM, Sartori CR, Parada CA, Tambeli CH. Anti-inflammatory effects of propranolol in the temporomandibular joint of female rats and its contribution to antinociceptive action. Eur J Pain. 2018 Mar;22(3):572-582. doi: 10.1002/ejp.1143. Epub 2017 Dec 11. PMID: 29226500.
  • Linde K, Rossnagel K. WITHDRAWN: Propranolol for migraine prophylaxis. Cochrane Database Syst Rev. 2017;2(2):CD003225. Published 2017 Feb 17. doi:10.1002/14651858.CD003225.pub3