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Is there any advantage for using timolol vice propranolol for headache Tx/Prophy? Had a Pt place on timolol 10 bid but it's more expensive than propranolol.

 

There is no known advantage. Timolol and propranolol are both considered Cat A (best evidence) in migraine prevention. It is true, however, that some patients respond to one beta blocker better than another and it can make sense to switch from one to another if the first one fails. But picking among propranolol, timolol and nadolol shouldn't made any difference, except for cost and convenience (for example Nadolol is a tablet which can be broken and is once a day dosing).

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