(FDA approved in bold)

• Migraine prophylaxis
  
• Hypertension
  
• Myocardial infarction
  
• Chronic open angle glaucoma or ocular hypertension (ocular solution)
  
• Congestive heart failure (stable)
  
• Angina pectoris due to coronary atherosclerosis
  
• Prevention of variceal bleeding

• Migraine: Proposed mechanisms include inhibition of adrenergic pathway, interaction with serotonin system and receptors, inhibition of nitric oxide production, and normalization of contingent negative variation. Prevention of cortical spreading depression may be the mechanism of action for all migraine preventives

• Migraines – within 2 weeks, but can take up to 3 months on a stable dose to see full effect

• In migraine, the goal is a 50% or greater decrease in migraine frequency or severity. Consider tapering or stopping if headaches remit for more than 6 months or if considering pregnancy

• Increase to highest tolerated dose
  
• Migraine: address other issues, such as medication-overuse, other coexisting medical disorders, such as anxiety, and consider changing to another drug or adding a second drug

• Migraine: For some patients, low-dose polytherapy with 2 or more drugs may be better tolerated and more effective than high-dose monotherapy. May use in combination with AEDs, antidepressants, natural products, and non-pharmacologic treatments, such as biofeedback, to improve headache control

• None required