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Propranolol in the Prophylaxis of Migraine - Evaluation by Spectral Analysis of Beat-to-Beat Heart Rate Fluctuations

Authors

  • Michel Zigelman M.Sc.,

    1. From the Dept. of Medical Physics, School of Physics and Astronomy, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel-Aviv University, Ramat-Aviv, 69978, Israel, and
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  • Arieh Kuritzky M.D.,

    1. Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, 69978, Israel;
    2. the Dept. of Neurology, Beilinson Med. Center, Petach-Tikvah, Israel, and
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  • Shlomo Appel M.D.,

    1. From the Dept. of Medical Physics, School of Physics and Astronomy, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel-Aviv University, Ramat-Aviv, 69978, Israel, and
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  • Simha Davidovitch M.D.,

    1. the Dept. of Neurology, Beilinson Med. Center, Petach-Tikvah, Israel, and
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  • Izhar Zahavi M.D.,

    1. the Dept. of Neurology, Beilinson Med. Center, Petach-Tikvah, Israel, and
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  • Rachel Hering M.D.,

    1. Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, 69978, Israel;
    2. the Dept. of Neurology, Beilinson Med. Center, Petach-Tikvah, Israel, and
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  • Solange Akselrod Ph.D.

    1. From the Dept. of Medical Physics, School of Physics and Astronomy, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel-Aviv University, Ramat-Aviv, 69978, Israel, and
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Abstract

SYNOPSIS

Migraine patients seem to suffer from a continuous autonomic imbalance. Sympathetic instability, expressed by enhancedlow frequency fluctuations, which exists during the headache free intervals, was observed in our previous study by spectral analysis of heart rate (HR) fluctuations. Propranolol - a beta adrenoceptor antagonist, is widely used in migraine prophylaxis.In order to specify and quantitate propranolol efficacy in migraine, spectral analysis of heart rate fluctuations was performedon 10 migraine patients before and during the treatment with propranolol. They were compared to 10 healthy control patientsand 6 migraine patients who Were treated for several months with propranolol and then discontinued the medication. The analysis was carried out on a 24h Holter ECG recording, which was performed for each subject during a headache freeinterval. Short 256 sec subtraces, taken every 30 min from the 24h ECG signal, were submitted to A/D conversion, R wavedetection and computation of heart rate power spectrum.

Propranolol achieved a marked effect, when comparing the power spectra of HR fluctuations in treated versus untreatedmigraine patients. A strong reduction (to normal level) in the low frequency HR fluctuations in the range below 0.1 Hz., wasapparent in patients treated with propranolol. Subjects who had received propranolol in the past and discontinued the drug,displayed a carry-over effect of reduced fluctuations even 2-3 months after its discontinuation. it seems that the propranololefficacy in migraine is associated with the mechanism of stabilizing the fluctuations within the frequency band related to sympathetic activity, hereby moderating the vascular instability in migraine.

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