Other Preventive Anti-Migraine Treatments: ACE Inhibitors, ARBs, Calcium Channel Blockers, Serotonin Antagonists, and NMDA Receptor Antagonists

  • Jill C. Rau
  • David W. DodickEmail author
Headache (JR Couch, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Headache


Purpose of review

Migraine causes more years of life lived with disability than almost any other condition in the world and can significantly impact the lives of individuals with migraine, their families, and society. The use of medication for the prevention of migraine is an integral component to reducing disability caused by migraine. There are many different drug classes that have been investigated and shown efficacy in migraine prophylaxis. This article examines several of the classes of medications that are used for migraine preventive treatment, specifically, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, serotonin antagonists, alpha-adrenergic agonists, and N-methyl-d-aspartic acid receptor antagonists.

Recent findings

There have been randomized control trials investigating medications in these drug classes since the most recent guidelines for migraine prevention in adults were published by the American Academy of Neurology, American Headache Society, and the Canadian Headache Society. In these investigations, enalapril, candesartan, and memantine all demonstrated efficacy for migraine prevention. The evidence for these and the aforementioned drug classes are reviewed.


When oral medications are being selected for migraine prevention, comorbid and coexistent medical conditions, concomitant medications, patient preference, and pregnancy and breast-feeding plans should be considered. Within the drug classes discussed, memantine and candesartan have a moderate level of evidence for efficacy.


Migraine Adult Prevention Medications 


Compliance with Ethical Standards

Conflict of Interest

David W. Dodick reports the following conflicts from within the past 48 months. Personal fees: Amgen, Autonomic technologies, Axsome, Allergan, Alder, Biohaven, Charleston Laboratories, Dr. Reddy’s Laboratories/Promius, Electrocore LLC, Eli Lilly, eNeura, Neurolief, Novartis, Ipsen, Impel, Satsuma, Supernus, Sun Pharma (India), Theranica, Teva, Vedanta, WL Gore, Zosano, ZP Opco, Foresite Capital, Oppenheimer, Arteaus, Pfizer, Colucid, Merck, NuPathe, Ethicon J&J, Zogenix, Labrys, Boston Scientific, Medtronic, St. Jude, Bristol-Myers Squibb, Lundbeck, Impax, MAP, Tonix, Alcobra, Insys, Acorda, Biocentric, Magellan, Xenon, CC Ford West Group, IntraMed, SAGE Publishing, Sun Pharma, American Academy of Neurology, Decision Resources, Synergy, Peer View Institute for Medical Education, MeetingLogiX, Wiley Blackwell. CME fees or Royalty payments: Healthlogix, Medicom, Medlogix, Mednet, Miller Medical, PeerView, WebMD/Medscape, Chameleon, Academy for Continued Healthcare Learning, Universal meeting management, Haymarket, Global Scientific Communications, UpToDate, Oxford University Press, Cambridge University Press, Wolters Kluwer Equity (stock options): Aural analytics, Healint, Theranica, Second Opinon/Mobile Health, Epien, GBS/Nocira, Matterhorn/Ontologics, King-Devick Technologies. Board of Directors: Aural analytics, Epien, Matterhorn/Ontologics, King-Devick Technologies. Patent: 17189376.1-1466:v Title: Botulinum Toxin Dosage Regimen for Chronic Migraine Prophylaxis. Professional society fees or reimbursement for travel: American Academy of Neurology, American Brain Foundation, American Headache Society, American Migraine Foundation, International Headache Society, Canadian Headache Society. Other: use agreement through employer Myndshft. Expense reimbursement from West Virginia University Foundation, Oregon Health Science Center, Albert Einstein University, University of Toronto, Starr Clinical, University of British Columbia, University of Southern California, and University of California, Los Angeles. Consulting use agreement through employer: Neuro-Assessment Systems.

Jill C. Rau reports personal fees from speaking at an Amgen sponsored educational event on a general topic outside the submitted work.

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.

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

Authors and Affiliations

  1. 1.Mayo ClinicScottsdaleUSA

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