Date: {{$ActivityAssignDate}}

Dear Dr. {{$doctorName}},


Subject: A multicentre, retrospective, observational survey study to analyse the role of Propranolol in adult female patients with migraine


Headache disorders are among the most prevalent neurologic disorders worldwide. Approximately 30% of adults in the age group 18–65 suffer from headache disorders and about 30% of these individuals have migraine.1 Female-to-male ratio of 3:1 and an estimated 1-year prevalence of approximately 15% in the general population. The prevalence peaks between the ages of 35 and 39 years, and about 75% of affected persons report the onset of migraine before the age of 35 years.2 The crude 1 year prevalence of any headache (n = 1,488) in the study population was 63.9 %, with female preponderance (73.0 % versus 54.4 % in males; OR = 2.3 [1.9-2.7]) and rural preponderance (71.2 % versus 57.3 % urban; OR = 1.8 [1.6-2.1].3 In the Global Burden of Disease study 2016, migraine was reported to be the second highest cause of years lived with disability in the world.4


Management includes lifestyle modifications, acute pharmacological treatment like NSAIDs, triptans and gepants, and, lastly, prophylactic treatment. Preventive medications form the basis of headache management and should be considered in the following cases


  1. Frequent headaches (four or more attacks per month or eight or more headache days per month)

  2. Failure, contraindications, side effects or abuse of acute medications

  3. Patient preference

  4. Presence of prolonged auras such as hemiplegic migraine, brainstem aura because they do not usually respond to acute treatment

  5. Impact on the patient’s quality of life and interference in their daily life despite correct treatment with lifestyle modification strategies and acute treatment of migraine

  6. Menstrual migraine

Oral drugs for migraine prophylaxis include the following therapeutic groups:


Anti- convulsants: topiramate, valproic acid, and gabapentin


Blood pressure medications: Beta/blockers (propranolol)


Anti-depressants: (amitriptyline)5


Propranolol is a nonselective beta-adrenergic receptor blocking agent possessing no other autonomic nervous system activity. It specifically competes with beta-adrenergic receptor agonist agents for available receptor sites. When access to beta-receptor sites is blocked by propranolol, the chronotropic, inotropic, and vasodilator responses to beta-adrenergic stimulation are decreased proportionately

The mechanism of the antimigraine effect of propranolol is by reducing the neuronal firing rate of noradrenergic neurons of the locus coeruleus. It inhibits nitric oxide production by blocking inducible nitric oxide synthase (NOS). Propranolol also inhibits kainite-induced currents and is synergistic with N-methyl-D-aspartate blockers, which reduce neuronal activity and have membrane-stabilizing properties.6 Beta adrenergic receptors have been demonstrated in the pial vessels of the brain.7


Betacap Plus (Propranolol + flunarizine) capsules and Betacap (Propranolol) tablets are marketed by Sun Pharmaceutical Industries Ltd. Although every product is marketed only after regulatory approval, it is important to know how it performs in day-to-day practice of individual medical practitioners. For this purpose, we have planned to conduct a survey to assess the role of Propranolol in adult female patients with migraine.


We invite you to participate in this data collection activity. All you need to do is to report on a standard form your experience with Propranolol in the normal course of your practice. If you agree to participate, you will need to fill data collection forms (which we call DCF).


We trust you and we are partners in promoting this well tolerated and effective drug therapy. In that spirit we hope you will consent to participate in this study. If you do, please sign and return the enclosed reply along with your visiting card for accuracy of records.





Yours truly,

Sun Pharma Laboratories Limited