ACE inhibitors/ARBs in migraine

Q: Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin Receptor Blockers (ARBs) tend to make migraine? - select one

A) Better

B) Worse

Answer: A

Beta-blockers (BBs) and Calcium Channel Blockers (CCBs) are well known for their use in migraine treatment. Less well known is that ACE inhibitors/ARBs can also be used as an adjuvant treatment in migraine, particularly in hypertensive patients. Lisinopril has been found to be one of the most effective agents for reducing the number of hours, days, and severity of migraine. Candesartan, an ARB, is another good choice.

ACE inhibitors/ARBs are effective during treatment, but data regarding their effectiveness in preventing migraines is lacking.

#neurology

#pharmacology

References:

1. Tronvik E, Stovner LJ, Helde G, et al. Prophylactic treatment of migraine with an angiotensin II receptor blocker: a randomized controlled trial. JAMA 2003; 289:65.

2. Stovner LJ, Linde M, Gravdahl GB, et al. A comparative study of candesartan versus propranolol for migraine prophylaxis: A randomised, triple-blind, placebo-controlled, double cross-over study. Cephalalgia 2014; 34:523.

3. Schrader H, Stovner LJ, Helde G, et al. Prophylactic treatment of migraine with angiotensin converting enzyme inhibitor (lisinopril): randomised, placebo controlled, crossover study. BMJ 2001; 322:19.