Beta blocker prescribed!

Cotterend

After several nasty episodes of migraine, my doctor has prescribed 10mg propanolol. He tells me it won't affect my cycling, but to watch my heart rate doesn't drop below 60.

That was a couple of days ago. So far, it's not looking good. My resting heart rate was high, a tad above 70. Now its 54. I went out on the bike. Normally I do between 30 and 50km, climbing between 500 and 700m, in 2 to 3 hours, coming back pretty spent. This time, I managed 16km and 200m in 45 minutes, I'd had enough, and came back just as spent. Heart rate was 60 as I put the bike away. I'd been pretty breathless on the ride, while energy levels seemed variable. My mood has been all over the place.

Now seeking out my old HR monitor. But has anyone experience with low dose beta blockers and their effect on performance?

svetty

If you cycle regularly I'd be surprised if your resting heart rate is ever over 60!

The Propranolol will have a slight effect to slow your heart - and thus reduce your peak performance/VO2max. Other migraine prophylactics exist......

ugo.santalucia

I would not take beta blockers for migraine... it's a slippery slope and to wean you out of beta blockers is quite dangerous. I would seek a second opinion from a consultant and try to get out of propanolol as quickly (and safely) as you can

sungod

are you 100% certain it's migraine? it can get used as a catchall term for any bad headache

fwiw i was told i had migraine rather than the completely different kind of bad headache i actually had, took many years and many many wrong/useless/side-effect-laden drugs to get the correct diagnosis/solution

try checking against...

http://bestpractice.bmj.com/best-practi ... nosis.html

Mad_Malx

At standard doses it can reduce bedroom performance. Lucid dreams also frequently reported.

sloppyschleckonds

I'd guess there is a little more to this story than the OP has posted.

Listen to your doctor

Cotterend

SloppySchleckonds wrote:

I'd guess there is a little more to this story than the OP has posted.
Listen to your doctor

There is a bit more, but not a lot.

I was surprised at the beta blockers, but I have also been struggling with regular 24 hour episodes of severe depression which I began to believe were post-silent-migraine episodes. All of these are associated with stress and fairly serious over-reaction to minor stresses, so I wondered if the doc had been clever and was trying to damp down stress reactions. However, he's a man of few words and what with his lack of English and my less-than-fluent French, even those words are not always useful!

I'm very tempted to simply stop them before things get any worse: I've only been on them three days. Then take stock. Monitor heart rates, look at alternatives, then maybe try again. Or not.

part time waster

Do you have a lot of caffine ? I find continued build up of it , plenty of espresso etc tips me over and is my trigger and accelerator of depression.
When I de tox and have none for a month , I level off. Then get the urge to have a few nice coffee`s then the cycle starts again. Minor irritation then depression.
Took me years to pin it down. It even gives me palpitations when I push on hard like on a chaingang.
Alcohol tips me over when im juiced on the coffee , not many pleasures left.
Good luck.

pirnie

Cotterend wrote:

I was surprised at the beta blockers, but I have also been struggling with regular 24 hour episodes of severe depression which I began to believe were post-silent-migraine episodes. All of these are associated with stress and fairly serious over-reaction to minor stresses, so I wondered if the doc had been clever and was trying to damp down stress reactions. However, he's a man of few words and what with his lack of English and my less-than-fluent French, even those words are not always useful!

My OH suffers from migraines and is on a prophylactic prescription of propanolol. It is a standard NHS treatment to try to reduce incidence of migraines if treatment with NSAIDs such as ibuprofen prove ineffective. I believe it works by preventing build up of blood pressure in the brain which triggers the migraine. It does seem to work for her and she's gone from more than 1 per week to less than one a month (which usually happens if she forgets to take the propanolol).

The other thing you can get is a triptan such as sumatriptan which will treat the migraine after it has started. This is one way to be sure they are migraines as if it doesn't help, you know the symptoms are caused by something different. It's not often prescribed though because its expensive so is generally only used if NSAIDs are contraindicated, or proving totally ineffective.

On the cycling side, she doesn't partake so I can't comment there unfortunately.

webboo

Cotterend wrote:

SloppySchleckonds wrote:

I'd guess there is a little more to this story than the OP has posted.
Listen to your doctor

There is a bit more, but not a lot.

I was surprised at the beta blockers, but I have also been struggling with regular 24 hour episodes of severe depression which I began to believe were post-silent-migraine episodes. All of these are associated with stress and fairly serious over-reaction to minor stresses, so I wondered if the doc had been clever and was trying to damp down stress reactions. However, he's a man of few words and what with his lack of English and my less-than-fluent French, even those words are not always useful!

I'm very tempted to simply stop them before things get any worse: I've only been on them three days. Then take stock. Monitor heart rates, look at alternatives, then maybe try again. Or not.

I would strongly suspect you are being treated for stress related anxiety rather than migraines with Beta blockers.

pirnie

Webboo wrote:

I would strongly suspect you are being treated for stress related anxiety rather than migraines with Beta blockers.

http://www.nhs.uk/Conditions/Migraine/Pages/Prevention.aspx

Beta blockers can definitely be used for migraine prophylaxis. However, it is possible the doc is trying to kill two birds with one stone as it were.

rafregt1

I suffered with chronic migraines all day everyday for two and a half years and was prescribed all sorts of different medication by my neurologist none of which really worked and to the point of getting bad side effects.
The neurologist told me to try a natural plant in capsule form that is bought over the counter from all health stores.
It's called "FEVERFEW" takes a couple of weeks to build up in your system and I've never had a migraine since just taking one a day.
Well worth trying and look at the reviews on line.
I know your pain as I've been there and it was really effecting everything including my cycling..
One to consider

svetty

ugo.santalucia wrote:

I would not take beta blockers for migraine... it's a slippery slope and to wean you out of beta blockers is quite dangerous. I would seek a second opinion from a consultant and try to get out of propanolol as quickly (and safely) as you can

I didn't realise you were a neurologist Ugo?

ugo.santalucia

Svetty wrote:

ugo.santalucia wrote:

I would not take beta blockers for migraine... it's a slippery slope and to wean you out of beta blockers is quite dangerous. I would seek a second opinion from a consultant and try to get out of propanolol as quickly (and safely) as you can

I didn't realise you were a neurologist Ugo?

I am not, I have a degree in pharmaceutical chemistry, as a matter of fact and a PhD in a less relevant branch of chemistry.

Beta blockers are over-prescribed these days, same as antibiotics are over prescribed, statins are over prescribed... most drugs are over prescribed. The problem with beta blockers is the long list of side effects that make them totally not worth it when used outside their original scope, which was that of controlling blood pressure and related issues.

For some reason the NHS have decided they can use them as an alternative to ibuprofen or pretty much anything else... which is totally bonkers

Cotterend

pirnie wrote:

..... it is possible the doc is trying to kill two birds with one stone as it were.

Hmm, yes, he nearly did!

I stopped them (I'd only been on them a few days so I didn't see this as dangerous), and they washed out quickly, within 24 hours I was coming back to normal and tested this on the bike. 2 hours, 25km, 800m climb, nicely within normal range.

I need a different way to control the migraine / anxiety. Beta blockers are not the answer.

joncomelately

Off the original topic, but in line with the latter part of the discussion...

From the NICE guidelines on migraine:



This is what I find hilarious about NICE; "The evidence is ropey at best, but we'll recommend it anyway".
Ugo, that's the "some reason" the NHS prescribes it - but don't ask me why the guiding body recommends they do!

ugo.santalucia

Cotterend wrote:

I need a different way to control the migraine / anxiety. Beta blockers are not the answer.

I agree and I also think the answer for either doesn't lie in a pill

Cotterend

ugo.santalucia wrote:

Cotterend wrote:

I need a different way to control the migraine / anxiety. Beta blockers are not the answer.

I agree and I also think the answer for either doesn't lie in a pill

I'm with you on this, more zen needed. Perhaps a little less of the bull-at-a-gate approach to life, perhaps I don't need to knock myself out cycling up every mountain.... although not doing so does sound a little boring

ugo.santalucia

Cotterend wrote:

ugo.santalucia wrote:

Cotterend wrote:

I need a different way to control the migraine / anxiety. Beta blockers are not the answer.

I agree and I also think the answer for either doesn't lie in a pill

I'm with you on this, more zen needed. Perhaps a little less of the bull-at-a-gate approach to life, perhaps I don't need to knock myself out cycling up every mountain.... although not doing so does sound a little boring

When I realised I was not getting any faster, I began to wonder how far I could go... and that unlocked a whole new world of challenges... might not solve your migrane issues, but it might do wonder for your anxiety...
Have a read and see what you think

https://whosatthewheel.com/2017/06/27/s ... ional-400/

Cotterend

ugo.santalucia wrote:

Cotterend wrote:

ugo.santalucia wrote:

Cotterend wrote:

I need a different way to control the migraine / anxiety. Beta blockers are not the answer.

I agree and I also think the answer for either doesn't lie in a pill

I'm with you on this, more zen needed. Perhaps a little less of the bull-at-a-gate approach to life, perhaps I don't need to knock myself out cycling up every mountain.... although not doing so does sound a little boring

When I realised I was not getting any faster, I began to wonder how far I could go... and that unlocked a whole new world of challenges... might not solve your migrane issues, but it might do wonder for your anxiety...
Have a read and see what you think

https://whosatthewheel.com/2017/06/27/s ... ional-400/

Interesting, thank you.

I used to be able to spend whole days cycling in the Alps (I lived in the foothills) and found huge relief in getting above 2000m, under my own steam. Living on my own, it didn't matter that I was wrecked for days afterwards. Now I run a B+B with my husband in the foothills of the Pyrenees, and am lucky enough to have two to three hours most days if I need them, but frustratingly never enough to really get up high and savour it all. And no longer really free to push myself to the same levels of exhaustion, I need to be live-able with afterwards!

And now every day, being on the Camino, we see off our guests, on foot and on bike, all embarking on a day-after-day mission with nothing more to do other than get to the next stop... I'm not jealous of them, but wonder how much of my anxiety comes from not getting up high, or would be relieved if I did.

The need to get high into the mountains and feel at one with them came after the suicide of my ex, the best times we had together being in the mountains. But now, it's about the mountains and the space, not the grief. I have to push my limits, and every so often, go beyond that certain point, where it becomes more an adventure than a cycle ride. I feel alive when I'm really pitted against the mountain, or the heat, or the exhaustion, I come back feeling buzzed up, buoyant.

Are you all the same, cyclists, or is just me??

tangled_metal

I got prescribed what was described by the consultant in the pain clinic as half dose beta blockers. I read up on them and spoke to ppl in the NHS that I know. Neither doctors but they asked around at work and one got told by a doctor friend she worked with not to start on them. That doctor went on them and had problems. She nearly.didn't go on them at first and regretted wavering the way she did. I handed them in to a local pharmacist for disposal.

BTW I had to go to a pain clinic to see a consultant to get the prescription. Apparently in the UK it is a level of medication that a gp is not allowed to.prescribe. I'd exhausted all the gp prescribed migraine remedies by that time.

A little point I've got to make about triptans. Someone posted that effectiveness of triptans can indicate whether it's a migraine or other headache mis-diagnosed. I've have had my migraine attacks confirmed as migraines by several GPs and a specialist consultant in the field however triptans do not always work with me. There must be a few reasons why but one is that the nature of my migraines include stomach issues. By the time a migraine is detected my stomach has effectively shut down. Tablets sit in there until I throw them up. When I do get them into my system either through taking them and they get absorbed or they get into my blood another way they still don't work that often. BTW I've tried triptans in tablet form, nasal spray and melt on your tree wafers (rizatriptan). The consultant gave my gp instructions to prescribe rizatriptan. It was the only triptan with evidence that it gets into the blood when stomach based tablets aren't absorbed. It works better than any other triptan I've tried but only reduced the severity of the migraine. My.migraines are very severe (aren't everyone's?), but seriously I'm very numb on one side and can only just walk because one side of my body is almost.paralysed.

The last solution offered was anti-depressants!. I got the drugs then looked them up. The gp was a little but naughty I think because she never told me they were anti-depressants. I never took them. I'd rather get the migraine.

BTW I'm over a year since my last migraine. Touch wood I've grown out of it or got lucky in cutting out the triggers. It's not a nice condition to have.

To the op I'd say get referred to a specialist. IMHO the local gp is not the best person to rely on with migraines. In the UK they are not able to prescribe all the possible drug based options. You'd need a consultant for that.

svetty

Love all the cranks and arm-chair medics jumping in on this. All is needed now is someone to advocate Homeopathy :roll: :roll:

Cotterend

Svetty wrote:

Love all the cranks and arm-chair medics jumping in on this. All is needed now is someone to advocate Homeopathy :roll: :roll:

A little unfair!

We can share experience and results of our research. It is valid because doctors seemingly do not treat holistically: mine should never have prescribed beta blockers after being told I cycled up mountains. He was stuck on 'stressy migraine, calm it down, hit the heart with beta blockers'.

He knows beta blockers but he doesn't know cycling. I know how to find cyclists who use or have used beta blockers. I can tap into a greater experience than my doctor has.

webboo

Cotterend wrote:

Svetty wrote:

Love all the cranks and arm-chair medics jumping in on this. All is needed now is someone to advocate Homeopathy :roll: :roll:

A little unfair!

We can share experience and results of our research. It is valid because doctors seemingly do not treat holistically: mine should never have prescribed beta blockers after being told I cycled up mountains. He was stuck on 'stressy migraine, calm it down, hit the heart with beta blockers'.

He knows beta blockers but he doesn't know cycling. I know how to find cyclists who use or have used beta blockers. I can tap into a greater experience than my doctor has.

Why is unfair there is no clinical evidence to prove Homeopathy works.
So you dilute a substance so that it cannot be found and it is supposed to work because it remembers the substance.
In that case could you not just put water in your petrol tank as it should be able to remember there's been petrol in there once.

tangled_metal

Unfair about the cranks and armchair medics comment I think he meant judging by how he went on about sharing experience.

GPs not treating holistically does not mean a comment on homeopathy IMHO. It refers to looking at the whole. The gp looked at migraine and gave a script for beta blockers, looking at more than the condition might have considered cycling as an important hobby might not be compatible.

http://dictionary.cambridge.org/diction ... h/holistic

BTW it's often the case a rushed gp who has had.too many over runs with appointments takes shortcuts. Scripts given for the condition and potential contra indications get missed.

Mad_Malx

Tangled Metal wrote:

The last solution offered was anti-depressants!. I got the drugs then looked them up. The gp was a little but naughty I think because she never told me they were anti-depressants. I never took them. I'd rather get the migraine.
.

If you are talking about Amitriptyline it's not being used here as an antidepressant. It inhibits pain pathways, so can be effective against migraine.

comment about the way this discussion is going: It's good to be cautious about your drugs, but many people get measurable benefits from the drugs described. If you have concerns talk them through with health professionals, rather than a load of random people on a cycling forum.

tangled_metal

Of course you talk to professionals or experts which means consultants not GPs IMHO. There are many treatments a gp can prescribe, including several drugs that are effective with a lot of people. They are not permitted to or too afraid of liability to prescribe other drugs. These need consultant input at pain or migraine clinics.

I went through this route which resulted in beta blockers being offered. The consultant encouraged that and told me a lot about the risks. However the conversation about risks were framed in a manner that left me thinking they weren't anything to worry about. Nothing about issues with coming off them.

The consultant did write a letter to my gp apparently never saw a copy) giving a list of alternatives should beta blockers not work. Rizatriptan in wafer format (maxalt melt) was one. I suspect that anti depressant drug could have been another. BTW it's a bit of an obfuscation to say it's not being used as an antidepressant as if that's makes any issues less. It's still in the class of drugs known as antidepressants even if it's used for other conditions.

There's a wide range of drugs developed for heart and mental health that has been investigated for.migraine treatment. Since these drugs affect blood flow/blood vessels their use.makes.sense. I'm sure there will be more classes of drugs entering the list of drugs available to migraine sufferers.

One more point, there is no reason why you can't go n through the medical professional route for drugs and discuss it with fellow sufferers. I've been to events / talks put on by the main migraine research charity with the purpose of putting sufferers together and for them to meet with leading researchers in the field of migraine and related conditions. It's common for many conditions. It's good for many reasons not least because most people only see their gp about it and I'm sorry but GPs don't really treat migraine sufferers that well. That's my experience and TBH the experience of other sufferers I've met at those events. My advice is to get a referral to a specialist if your migraines become either very frequent or very severe. That is my only advice, the rest of what I've posted is just my experiences. I make no claim that any of my experiences will be yours. I do believe this one advice offered would apply to anyone that meets the criteria I've described.

Mad_Malx

Tangled Metal wrote:

.
There's a wide range of drugs developed for heart and mental health that has been investigated for.migraine treatment. Since these drugs affect blood flow/blood vessels their use.makes.sense.

Yes

My advice is to get a referral to a specialist if your migraines become either very frequent or very severe.

Absolutely

ugo.santalucia

Webboo wrote:

Why is unfair there is no clinical evidence to prove Homeopathy works.
So you dilute a substance so that it cannot be found and it is supposed to work because it remembers the substance.
In that case could you not just put water in your petrol tank as it should be able to remember there's been petrol in there once.

Whether homeopathy is a placebo or not is irrelevant. If it alleviates your symptoms with zero side effects, you shouldn't bother questioning whether it comes from placebo effect or not. If you can get the same placebo by suckling a splinter of wood at no cost, great, problem is most people only experience placebo if they believe in the product they are trying out.

tangled_metal

Also no harm in charging lots for it and offering it to desperate ppl that have no hope. If anyone has the money to pay for it then it's their money. Personally I don't believe it should be paid for on the NHS on the off chance it works.

webboo

Tangled Metal wrote:

Also no harm in charging lots for it and offering it to desperate ppl that have no hope. If anyone has the money to pay for it then it's their money. Personally I don't believe it should be paid for on the NHS on the off chance it works.

+1