Q:I am aged 36, married with a young daughter and I have suffered with migraine for the past three years. The hospital consultant has described it as classic migraine. Migraine runs in my family with my grandmother, mother, two aunts and a first cousin all suffering from it. My GP has put me on Tenormin (atenolol) tablets 100 mg daily in a calendar pack. I have been taking this for six months now and have noted that while the frequency of migraine has reduced from one or two a week to one or maybe two a month (generally around menstruation) there are some side effects. I feel depressed a lot of the time for no apparent reason and my periods are now slightly irregular. Please can you tell me if these side effects are normal and if Tenormin is the most effective medication for treating migraine, as I understand it's generally used for high blood pressure which I don't suffer from. Also, we are considering the possibility of having a second child. Is it safe to take during pregnancy and if not, are there any alternatives? What is known of the long term effects of such medication and how long do patients generally stay on it? S.D., York.

A:As you rightly point out, Tenormin is listed in the Datasheet Compendium for managing hypertension, cardiac dysrhythmias, angina and early heart attacks only. That hasn't stopped doctors from trying it out on their migraine patients at the same dosage as heart patients, which is what you're getting.Typical side effects include coldness of the extremities, muscular fatigue, sleep disturbances, skin rash, dry eyes and also depression. Beta blockers, which Tenormin is, can also can cause sexual dysfunction, dizziness, sleepiness, sudden drop in blood pressure, hallucinations, a lowering of blood sugar level, liver and kidney function impairment.

Although Stuart Pharmaceuticals says that the drug has been used effectively under close supervision for heart patients who become pregnant, they were not given the drug until their 20th week of pregnancy. Furthermore, they know that Tenormin crosses the placenta and shows up in three fold accumulation in breast milk. "The possibility of foetal injury cannot be excluded," says Stuart, which means they don't know what it does.

We asked Dr. John Mansfield, our migraine expert, his feelings about the drug. As with all drug therapy, he said, at best it will suppress symptoms without dealing with the cause. He recommends that most elimination diets supervised by an experienced allergist or clinical ecologist normally pick up the cause of migraine, which in some 85 per cent of people is caused by food sensitivity (in the rest, chemical sensitivity or candida albicans). Once the offenders have been located, in his view some 95 per cent of migraine sufferers can be helped.

As we've mentioned before in these pages, Dr Mansfield details his entire drug free approach (and that of many other allergists) to migraine in his book The Migraine Revolution (Thorsons, £4.99).

The most persistent causes are the five most common allergens: wheat, corn, sugar, milk, eggs and oranges.