Bisoprolol (Zebeta) is one of about a dozen drugs in the beta-blocker family, medications that were developed for the treatment of high blood pressure, or hypertension. The oldest beta blocker, propranolol (Inderal) was approved by the FDA for the treatment of hypertension about 60 years ago and a decade later it was also approved for the prevention of migraine headaches. Timolol (Blocadren) is the only other beta blocker that is officially approved for migraines, but most likely they all work. Even though they are very similar, beta blockers may have different efficacy and especially, different side effects from patient to patient. A drug that works well and without side effects in one person may cause side effects in the next. Also, not all beta blockers have been subjected to rigorous double-blind trials for the prevention of migraines, so we tend to prescribe the ones that do have some evidence supporting their efficacy in migraines.
Bisoprolol is one of the beta blockers that has scientific evidence suporting its use in migraines. A blinded study comparing bisoprolol, 5 mg with metoprolol (Lopressor, Toprol), 100 mg, another beta blocker showed them to be equally effective in the treatment of migraines.
The European Federation of Neurological Societies recommends bisoprolol as a second-line beta blocker for the prophylactic treatment of migraine headaches, after propranolol and metoprolol. THe US guidelines list bisoprolol further down the list.
