Advertisement

Efficacy of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in the Preventative Treatment of Episodic Migraine in Adults

  • T. Dorosch
  • C. A. GanzerEmail author
  • M. Lin
  • A. Seifan
Episodic Migraine (S Nahas, Section Editor)
  • 13 Downloads
Part of the following topical collections:
  1. Topical Collection on Episodic Migraine

Abstract

Purpose of Review

Systematic review of angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARB) in the prophylactic treatment of adults with migraine. To identify gaps in research and provide guidance for future clinical trials.

Recent Findings

A search was completed using PubMed, MEDLINE, Embase, and the Cochrane Library January 1, 1990 through December 31, 2017. The following are keywords used in the search: migraine, migraine prophylaxis/prevention, renin-angiotensin-aldosterone system, RAAS, ACE inhibitors, angiotensin-converting enzyme inhibitors: quinapril, perindopril, ramipril, captopril, enalapril, lisinopril, benazepril, fosinopril. Angiotensin receptor blockers, ARB, angiotensin II receptor antagonists: candesartan cilexetil, irbesartan, olmesartan, valsartan, losartan, azilsartan medoxomil, telmisartan, and eprosartan. The search included randomized controlled trials (RCT), systemic reviews and open-label studies of ACE inhibitors and ARB for the prevention of migraine attacks in adults 18–70 years old. Of 2461 retrieved articles, 18 included RCT, meta-analysis, systemic reviews, or guidelines published on ACE inhibitors or ARB in the prevention of migraine. Three RCT with telmisartan 80 mg, candesartan 16 mg, and enalapril 10 mg, and two open-label trials with lisinopril 5 mg and ramipril 5 mg found a high number of responders with greater than 50 % reduction in migraine attack frequency when compared to a 4-week baseline period. Candesartan was superior to placebo while telmisartan and enalapril were not.

Summary

Lipophilic ACE inhibitors and ARBs can be effective prophylactic agents for reduction of migraine frequency in adults. Based on the limited number of published trials and small sample size, they are not recommended as first-line prophylactic agents. However, in populations with co-morbidities such as hypertension, they may be useful as first- or second-line prophylactics. Additional trials following the International Headache Society’s guidelines on RCT are warranted.

Keywords

Angiotensin-converting enzyme inhibitors Angiotensin receptor blockers Headache Migraine 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Smitherman TA, Burch R, Sheikh H, Loder E. The prevalence, impact, and treatment of migraine and severe headaches in the United States: a review of statistics from national surveillance studies. Headache: The Journal of Head and Face Pain. 2013;53(3):427–36.CrossRefGoogle Scholar
  2. 2.
    Raval AD, Shah A. National trends in direct health care expenditures among US adults with migraine: 2004 to 2013. J Pain. 2017;18(1):96–107.CrossRefGoogle Scholar
  3. 3.
    Rapoport AM. Acute and prophylactic treatments for migraine: present and future. Neurol Sci. 2008;29(1):110–22.CrossRefGoogle Scholar
  4. 4.
    Silberstein S, Tfelt-Hansen P, Dodick DW, Limmroth V, Lipton R, Pascual J, et al. Guidelines for controlled trials of prophylactic treatment of chronic migraine in adults. Cephalalgia. 2008;28(5):484–95.CrossRefGoogle Scholar
  5. 5.
    Nandha R, Singh H. Renin angiotensin system: a novel target for migraine prophylaxis. Indian J Pharm. 2012;44(2):157.CrossRefGoogle Scholar
  6. 6.
    Galletti F, Cupini LM, Corbelli I, Calabresi P, Sarchielli P. Pathophysiological basis of migraine prophylaxis. Prog Neurobiol. 2009;89(2):176–92.CrossRefGoogle Scholar
  7. 7.
    Burnier M. Telmisartan: a different angiotensin II receptor blocker protecting a different population? J Int Med Res. 2009;37(6):1662–79.CrossRefGoogle Scholar
  8. 8.
    Pringsheim T, Davenport WJ, Becker WJ. Prophylaxis of migraine headache. Cmaj. 2010;182(7):E269–E276. Epub 2010/02/18.CrossRefGoogle Scholar
  9. 9.
    U.S. Preventive Services Task Force. Guildeline to clinical preventive services. Baltimore. p. 1989.Google Scholar
  10. 10.
    Stovner LJ, Linde M, Gravdahl GB, Tronvik E, Aamodt AH, Sand T, 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(7):523–32.CrossRefGoogle Scholar
  11. 11.
    Diener H, Gendolla A, Fruersenger A, Evers S, Straube A, Schumacher H, et al. Telmisartan in migraine prophylaxis: a randomized, placebo-controlled trial. Cephalalgia. 2009;29(9):921–7.CrossRefGoogle Scholar
  12. 12.
    Sonbolestan SA, Heshmat K, Javanmard SH, Saadatnia M. Efficacy of enalapril in migraine prophylaxis: a randomized, double-blind, placebo-controlled trial. Int J Prev Med. 2013;4(1):72.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Tronvik E, Stovner LJ, Helde G, Sand T, Bovim G. Prophylactic treatment of migraine with an angiotensin II receptor blocker: a randomized controlled trial. JAMA : J Am Med Assoc. 2003;289(1):65–9.CrossRefGoogle Scholar
  14. 14.
    Park H-J, Lee S-T, Kim M. Inhibitory control of angiotensin-converting enzyme by ramipril in migraine. Neurology Asia. 2013;18(3):289–91.Google Scholar
  15. 15.
    Schuh-Hofer S, Flach U, Meisel A, Israel H, Reuter U, Arnold G. Efficacy of lisinopril in migraine prophylaxis–an open label study. Eur J Neurol. 2007;14(6):701–3.CrossRefGoogle Scholar
  16. 16.
    Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie SN, et al. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012;39(2 Suppl 2):S1–59.PubMedGoogle Scholar
  17. 17.
    Shamliyan TA, Choi J-Y, Ramakrishnan R, Miller JB, Wang S-Y, Taylor FR, et al. Preventive pharmacologic treatments for episodic migraine in adults. J Gen Intern Med. 2013;28(9):1225–37.CrossRefGoogle Scholar
  18. 18.
    • Ikeda K, Hanashiro S, Ishikawa Y, Sawada M, Kyuzen M, Morioka H, et al. Treatment with telmisartan, a long-acting angiotensin II receptor blocker, prevents migraine attacks in Japanese non-responders to lomerizine. Neurol Sci. 2017;38(5):827–31 This manuscript demonstrates the efficacy of telmisartan for the treatment of migraines. CrossRefGoogle Scholar
  19. 19.
    Barbanti P, Aurilia C, Egeo G, Fofi L. Migraine prophylaxis: what is new and what we need? Neurol Sci. 2011;32(1):111.CrossRefGoogle Scholar
  20. 20.
    Lipton RB, Manack Adams A, Buse DC, Fanning KM, Reed ML. A comparison of the chronic migraine epidemiology and outcomes (CaMEO) study and American migraine prevalence and prevention (AMPP) study: demographics and headache-related disability. Headache: The Journal of Head and Face Pain. 2016;56(8):1280–9.CrossRefGoogle Scholar
  21. 21.
    Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schünemann HJ. What is “quality of evidence” and why is it important to clinicians? BMJ (Clinical research ed). 2008;336(7651):995–8.CrossRefGoogle Scholar
  22. 22.
    Moschiano F, D’Amico D, Bussone G. Migraine prophylaxis: key points for the practising clinician. Neurol Sci. 2009;30(1):33–7.CrossRefGoogle Scholar
  23. 23.
    • Halker RB, Starling AJ, Vargas BB, Schwedt TJ. ACE and ARB agents in the prophylactic therapy of migraine-how effective are they? Curr Treat Options Neurol. 2016;18(4):15 This paper provides evidence based on clinical trials that ACE inhibitors and ARBs are effective and generally well tolerated when used for migraine prophylaxis. CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Barry UniversityMiamiUSA
  2. 2.Hunter-Bellevue School of Nursing, School of Health ProfessionsHunter College, CUNYNew YorkUSA
  3. 3.Nova SoutheasternFt. LauderdaleUSA
  4. 4.Neuro Well Free©Oakland ParkUSA

Personalised recommendations