August 2023
Wide range of antihypertensives reduce headache frequency in migraine
By Rebecca Jenkins
A wider range of blood pressure-lowering medication than currently recommended can reduce headache frequency in migraine, Australian research finds.
The study authors, led by researchers at the George Institute for Global Health in Sydney, said only a few specific blood pressure-lowering medications were currently recommended for migraine prevention, with uncertainty around the role of other agents.
To address this knowledge gap, they performed a systematic review of all randomised trials of blood pressure-lowering medications on the prevention of episodic migraine, defined as fewer than 15 headache days per month. They then included 50 international trials in a meta-analysis, incorporating data from more than 4300 people with a mean age of 39 years, 79% of whom were women.
Classes of antihypertensive medications analysed included alpha blockers, angiotensin II receptor blockers, ACE inhibitors, beta blockers and calcium channel blockers.
Writing in Cephalagia, the authors said that monthly headache days were fewer in all classes compared with placebo. This effect was statistically significant for all classes, except for ACE inhibitors and combination therapy where there were too few studies to perform a meta-analysis.
The effect was also separately statistically significant for some specific drugs within classes: clonidine, candesartan, atenolol, bisoprolol, propranolol, timolol, nicardipine and verapamil.
On average, blood pressure lowering medication reduced the number of monthly headache days by about one day on top of the average placebo effect.
Study limitations included the small sample size and the limited number of studies for all classes except for beta blockers, the authors noted.
Commenting on the findings, Professor Richard Stark, Neurologist for Alfred Health in Melbourne, said it was worthwhile bringing all the current information on this question together, but the analysis’s usefulness was constrained by the limited available data on blood pressure-lowering agents for migraine.
‘The difficulty we have is that there have only been decent trials done on a few of these agents,’ he told Medicine Today.
In clinical practice, Professor Stark said when assessing a patient with troublesome migraine who was already taking a medication for hypertension, he was inclined to switch them to a blood pressure lowering agent known to prevent headache, such as candesartan or propranolol However, Professor Stark noted blood pressure-lowering agents could also help patients with migraine who were not hypertensive, raising interesting questions about their mechanism.
‘You don’t have to have high blood pressure to start off with for the blood pressure-lowering medications to work for migraine,’ he said. ‘And to me, that [potentially] implies that the intrinsic property isn’t getting the blood pressure right. It’s some other beneficial side issue.’
Cephalagia 2023; 43(6); doi: 10.1177/03331024231183166.
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