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Timolol, a nonselective beta-adrenergic antagonist, is an established prophylactic agent for migraine but has recently gained interest as a potential acute treatment option when delivered via ophthalmic or nasal routes. Due to rapid systemic absorption via the nasolacrimal duct, ophthalmic timolol has demonstrated significant bioavailability, suggesting that a nasal spray formulation could offer an efficient, non-oral alternative for patients unable to tolerate or afford conventional therapies. This literature review examines the pharmacokinetics, clinical data, and therapeutic feasibility of timolol nasal spray for acute migraine management. Preliminary studies and case reports indicate potential efficacy; however, methodological inconsistencies and limited clinical trials preclude definitive conclusions. While compounded timolol nasal spray may provide a viable treatment option for select patients, further well-designed, placebo-controlled trials are needed to confirm its efficacy, optimize dosing, and establish safety parameters.