Blood pressure-lowering meds more effective than placebo at reducing migraine frequency

Key takeaways:

• Literature review examined 50 studies with 4,310 adults given blood pressure lowering drugs or placebo to treat headache.
• Across all classes of drugs, headache frequency was reduced compared with placebo.

A systematic literature review determined that various classes of blood pressure-lowering medication reduced frequency of migraine days per month compared with placebo, according to a study published in Cephalalgia.

“Among blood pressure-lowering medications, beta-blockers, including atenolol, bisoprolol, metaprolol, nadolol and propranolol and the angiotension II receptor blocker candesartan are suggested by guidelines for the prevention of migraine,” Cheryl Carcel, MD, PhD, neurologist and senior research fellow at The George Institute for Global Health, University of New South Wales, Australia, and colleagues wrote.

Researchers engaged in a literature review to determine whether any additional classes of drugs, aside from the above-mentioned therapeutics, were beneficial in treating migraine.

They searched Embase, MEDLINE, and the Cochrane Central Registry of Controlled Trials and included 50 (70% of which were crossovers) randomized controlled trials including 4,310 participants (mean age 39 years; 79% female) that examined effects of blood pressure-lowering medications compared with placebo in participants aged 18 years and older diagnosed with episodic migraine. Data were collected on the evaluative outcome of headache/migraine frequency, as well as four separate outcomes: monthly headache or migraine days, and monthly headache or migraine attacks, with a standardized mean difference calculated for overall. Random effect meta-analysis was performed where at least two studies were available on each outcome.

According to results, the search yielded 60 total comparisons from the 50 studies.

Compared with placebo, the number of monthly headache days were fewer in all classes, with statistical significance for all but alpha-blockers 0.7 (95% CI, 1.2, 0.1), angiotensin-converting enzyme inhibitors 1.3 (95% CI, 2.9, 0.2), angiotensin II receptor blockers 0.9 (1.6, 0.1), beta-blockers 0.4 (0.8, 0.0) and calcium channel blockers 1.8 (3.4, 0.2). Standardized mean difference was significantly reduced for all drug classes and was separately significant for clonidine, candesartan, atenolol, bisoprolol, metoprolol, propranolol, timolol, nicardipine and verapamil.

“These data suggest that new trials using blood pressure-lowering medications and conforming to present guidelines for migraine prevention might be useful,” Carcel and colleagues wrote.