ACE Inhibitors, ARBs May Be Effective Migraine Prophylactic Treatments

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may represent effective migraine prophylactic treatments.

The following article is part of conference coverage from the 2019 American Academy of Neurology Annual Meeting (AAN 2019) in Philadelphia, PA. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAN 2019.

PHILADELPHIA — Angiotensin-converting enzyme or ACE inhibitors and angiotensin receptor blockers (ARBs) may represent effective migraine prophylactic treatments, according to the results of a systematic review presented at the 2019 American Academy of Neurology Annual Meeting, held May 4-10 in Philadelphia, Pennsylvania.

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ARBs and ACE inhibitors are thought to prevent the occurrence of migraine through a number of mechanisms that include promotion of vasoconstriction and reduction in pro-inflammatory cytokine levels. In addition, these agents are associated with fewer side effects and lower costs compared with medications that have been approved by the US Food and Drug Administration (FDA) for migraine prophylaxis.

For the systematic review, investigators searched electronic medical databases for meta-analyses and randomized trials published between 2007 and 2017 in which the effects of ARBs and ACE inhibitors on preventing migraine were examined in adults  18 to 70. Studies included in the review had ≥20 participants enrolled who did not have a cluster or tension-type headache diagnosis. Keywords used in the search included ACE inhibitor, ARB, ACE inhibitor and ARB drug names (eg, quinapril, perindopril, cilexetil, telmisartan, enalapril, and candesartan), and migraine.

A total of 3 randomized trials and 1 meta-analysis were selected for analysis. The anti-hypertensive drug candesartan was found to reduce the number of migraine days by >50% in 43% of participants compared with 23% of patients treated with placebo (P =.025). After adjusting for study site, the number of migraine days were reduced by 38% in participants treated with telmisartan vs 15% in participants given placebo (P =.0262). A greater percentage of participants treated with enalapril vs placebo reported a 50% reduction in headache severity (48% vs 11%, respectively; P =.016). The treatment was also associated with a reduction in migraine frequency (13 to 11 attacks per month; P <.001). ARBs were found to be superior to placebo for reducing headache frequency in the meta-analysis (mean difference in number of headaches per month, −1.1).

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Dorosh T, Ryon K, Ganzer C, Seifan A. Angiotensin receptor blockers and ACE inhibitors for migraine prophylaxis — a systematic review. Presented at: 2019 American Academy of Neurology Annual Meeting. May 4-10, 2019; Philadelphia, Pennsylvania.