Kansas City doctors found a better, cheaper way to stop migraine headaches | Opinion

Few diseases cause as much misery as migraine headaches, the world’s most prevalent neurological malady. More than 1 billion people get migraines. Almost all are young, and most are female. Migraines are a common cause of missed work. They affect about 10% of school children and 20% of women, and generate an emergency room visit every 10 seconds. Lost productivity and migraine-associated medical expenses are estimated at more than $40 billion per year.

Numerous medications are used to treat migraines. Often, they don’t work well. Others are outrageously expensive, costing over $10,000 per year. Still, 80% of migraine patients want a medicine more effective than what they currently use.

Innovative research done in Kansas City, now validated worldwide, offers hope for an effective, safe, inexpensive and immediately available treatment for acute migraine. This unique approach repurposes timolol eyedrops, a beta-blocker drug used to treat glaucoma.

In the 1990s, Carl Migliazzo, an Overland Park ophthalmologist, noted when glaucoma patients with migraine were put on beta-blocker eyedrops, they often reported that their headaches got better. Inventively, he then used the beta-blocker glaucoma eyedrops to treat acute migraines successfully. I joined his research 15 years ago. Timolol pills taken daily are approved by the U.S. Food and Drug Administration for migraine prevention. However, taken sporadically in pill form at first onset of headache, oral timolol is ineffective. We investigated this seeming paradox.

Migraines have been likened to the brain catching on fire. Migraines and fire both need to be extinguished quickly before they flame out of control. Our research showed that beta-blocker pills get in the blood far too slowly to quench migraines. But timolol eyedrops under the tongue, properly instilled onto normal eyes or by nasal spray — the easiest way — reach therapeutic blood levels in 10 to 15 minutes. Pills are too little too late. Eyedrops outpace the migraine and extinguish the pain before the brain burns.

In 2014, using timolol eyedrops, Dr. Migliazzo and I reported the world’s first successful acute migraine case series in the medical journal Missouri Medicine. The first prospective placebo-controlled study, reported in JAMA Neurology, was done at University Health Truman Medical Center by ophthalmologist Sean Gratton and others in 2018. Two years later, researchers in India confirmed the positive Kansas City research.

Bolstered by these successful studies, I have spent more than a decade trying to persuade pharmaceutical companies to develop an FDA-approved timolol nasal spray for acute migraine. More than two dozen companies have said the same thing: “We won’t make enough money,” or, “We don’t want a low-cost effective medication to compete with our much more profitable patented medicines.” I have long since lost my respect for profit-driven pharma.

Steve Kosa, a neurologist who runs a headache referral clinic in North Kansas City, has greatly advanced our research over the past five years. He and I approached O’Brien Pharmacy, headquartered in Mission, to produce a compounded timolol nasal spray. Dr. Kosa’s difficult patients are referred to him after failing standard migraine therapy. In 2024, we published the world’s first successful treatment with beta-blocker nasal spray for severe migraine patients. Presently, the 0.5% timolol nasal spray is available from O’Brien with a proper prescription at a cost of $77.45 for enough to treat 75 migraines. Other headache medications, such as analgesics, can be taken and apparently work synergistically.

Some caveats: No medication works every time for everyone, and timolol eyedrops for migraine are no exception. Some people should not take beta-blockers. Monitoring for side effects is essential.

Discuss this off-label treatment with your physician. Many doctors are uninformed or incompletely informed about the success of nasal spray timolol for acute migraine. Regrettably, it often takes 10 to 15 years for even breakthrough therapies to become standard treatment. Ask your doctor to do a medical literature search.

When it comes to acute migraine therapy, everything is up to date in Kansas City.

John C. Hagan III is a Kansas City Northland ophthalmologist and migraine researcher. He is editor of the medical journal Missouri Medicine and contributing editor of The Kansas City Medicine Journal.