Compounded Beta-blocker Nasal Spray for Treatment of Acute Migraine: A New Therapeutic Modality.

Beta blockers (timolol 0.5% ophthalmic solution) delivered topically to the eyes or sublingually have recently been reported in case series and small placebo controlled studies to be effective in some cases of acute migraine. Rapid systemic absorption to achieve therapeutic levels of beta blockers is extremely important in the treatment of acute migraine. Nasal delivered beta blockers have been shown to be absorbed as fast as intravenous administration and seem ideal for acute migraine treatment. A nasal delivered beta-blocker spray has not been available. In 2019, O'Brien Pharmacy prepared a compounded timolol nasal spray that is now available to authorized prescribers. The theoretical basis for using nasal beta blocker spray is presented and research on fast-acting beta-blocker solutions for acute migraine is reviewed.