Beta-Blockers, Stage Fright, and Vibrato: A Case Report

This case report describes negative effects of beta-adrenergic blocker treatment of stage fright and hypertension in a professional violinist. A literature search from 1966 to 2005 was performed, and clinical studies of b-blocker treatment for musicians with stage fright were reviewed. The literature was also searched for clinical and physiologic studies on the effects of b-blockers on tremor and on the production of rapid oscillatory movements. In our patient, daily b-blocker treatment for hypertension caused impairment of vibrato, a form of voluntary tremor that is an essential part of violin technique. Impairment of vibrato was not seen with intermittent use of a b-blocker for treatment of stage fright, although fatigue and weakness were noted. b-blockers effectively treat many of the sympathetic-overload symptoms that cause stage fright in musicians, although we postulate that in some cases they may suppress beta2 sympathetic tone below a threshold level for voluntary tremor production, which can impair vibrato technique.