Blood Pressure-Lowering Medications Reduce Episodic Migraine Frequency

Some classes of blood pressure-lowering medications can potentially reduce the migraine or headache frequency in patients who experience episodic migraines, according to study findings in published in the journal Cephalalgia.

There are a few blood pressure-lowering medications suggested for the prevention of migraines according to certain treatment guidelines. However, information on whether these benefits extend to other classes of medications is limited. Researchers conducted a systematic review to assess the effects of different antihypertensive medications on migraine prevention. 

Researchers collected data from Embase, MEDLINE, and the Cochrane Central Registry of Controlled Trials. All studies screened for analysis were randomized trials that assessed the effectiveness of blood pressure-lowering medications on episodic migraine prevention. Episodic migraines were defined as less than 15 headache days in 1 month. 

The study population included adult patients aged 18 years and older taking antihypertensive medications that were compared with placebo. The drug classes considered for inclusion were angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), alpha-blockers (AB), beta-blockers (BB), calcium channel blockers (CCB), and combination antihypertensives. 

There were 4 frequency outcomes reported in this study: headache days per month, headache attacks per month, migraine days per month, and migraine attacks per month. 

A total of 50 trials with 4310 participants (mean age, 39 years; 79% women) that made 60 comparisons against placebo were included. Of these studies, 70% had a crossover design.

The researchers reported a lower number of monthly headache days in the treatment groups when compared with placebo. 

With the exception of ACEi, all other groups showed a greater reduction in headache days compared with the placebo group:

• -0.7 (95% CI, -1.2 to -0.1) for AB,
• -1.3 (95% CI, -2.9 to 0.2) for ACEi,
• -0.9 (95% CI -1.6 to -0.1) for ARBs,
• -0.4 (95% CI, -0.8 to 0.0) for BBs, and
• -1.8 (95% CI, -3.4 to -0.2) for CCBs. 

The researchers reported a significant reduction in the standardized mean difference across all drug classes. Additionally, the analysis showed that the standardized mean differences for the following drugs were separately significant: clonidine, candesartan, atenolol, bisoprolol, metoprolol, propranolol, timolol, nicardipine, and verapamil.

The researchers wrote, “These data suggest that new trials using BP-lowering medications and conforming to present guidelines for migraine prevention might be useful.”

Study limitations included the small sample size for most drug classes, the inclusion of outdated studies, and the inability to differentiate between migraines and other headache disorders in some studies. 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.