Candesartan in migraine prevention: results from a retrospective real-world study


Randomized studies have reported a positive effect of candesartan, an angiotensin II receptor antagonist, in migraine prevention. The aim of our study was to explore patient subjective efficacy of candesartan in a real-world sample of migraine patients and try to identify predictors of candesartan response. We audited the clinical records of 253 patients who attended the King’s College Hospital, London, from February 2015 to December 2017, looking specifically at their response to candesartan. Univariate and multivariate logistic regression models were used to identify predictors of headache benefit. Odds ratios (OR) with confidence intervals (CI) 95% were calculated. Eighty-one patients (chronic migraine, n = 68) were included in the final analysis. Thirty-eight patients reported a positive response to candesartan, while 43 patients did not have a meaningful therapeutic effect. The median dose of candesartan was 8 mg and the median treatment period was 6 months. In a univariate logistic regression model, the presence of daily headache was associated with reduced odds of headache benefit (OR 0.39, 95% CI 0.16–0.96, p = 0.04). In multivariate logistic regression model, younger age (OR 0.92, 95% CI 0.87–0.98, p = 0.006) and longer disease duration (OR 1.06, 95% CI 1.01–1.12, p = 0.03) were associated with a good response to candesartan, while the presence of daily headache was associated with reduced odds of headache benefit (OR 0.16, 95% CI 0.04–0.71, p = 0.01). Having failed up to nine preventives in patients did not predict a treatment failure with candesartan as well. Candesartan yields clinical benefits in difficult-to-treat migraine patients, irrespective of previous failed preventives.

This is a preview of subscription content, log in to check access.


  1. 1.

    Migraine CA (2017) N Engl J Med 377(17):1698–1699

    Article  Google Scholar 

  2. 2.

    Dodick DW (2019) CGRP ligand and receptor monoclonal antibodies for migraine prevention: evidence review and clinical implications. Cephalalgia 39(3):445–458

    Article  Google Scholar 

  3. 3.

    American Headache Society (2019) The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache 59(1):1–18

    Google Scholar 

  4. 4.

    Tronvik E, Stovner LJ, Helde G, Sand T, Bovim G (2003) Prophylactic treatment of migraine with an angiotensin II receptor blocker: a randomized controlled trial. JAMA 289(1):65–69

    CAS  Article  Google Scholar 

  5. 5.

    Stovner LJ, Linde M, Gravdahl GB, Tronvik E, Aamodt AH, Sand T et al (2014) A comparative study of candesartan versus propranolol for migraine prophylaxis: a randomised, triple-blind, placebo-controlled, double cross-over study. Cephalalgia 34(7):523–532

    Article  Google Scholar 

  6. 6.

    Owada K (2004) Efficacy of candesartan in the treatment of migraine in hypertensive patients. Hypertens Res 27(6):441–446

    CAS  Article  Google Scholar 

  7. 7.

    Messina R, Lastarria C, Filippi M, Goadsby PJ (2018) Predicting treatment response to candesartan in migraine patients. Eur J Neurol 25(Suppl 2):112

    Google Scholar 

  8. 8.

    Silberstein SD (2015) Preventive migraine treatment. Continuum 21(4):973–989

    PubMed  Google Scholar 

  9. 9.

    Headache Classification Committee of the IHS (2013) The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 33(9):629–808

    Article  Google Scholar 

  10. 10.

    Eross EJ, Gladstone JP, Lewis S, Rogers R, Dodick DW (2005) Duration of migraine is a predictor for response to botulinum toxin type A. Headache 45(4):308–314

    Article  Google Scholar 

  11. 11.

    Dominguez C, Pozo-Rosich P, Torres-Ferrus M, Hernandez-Beltran N, Jurado-Cobo C, Gonzalez-Oria C et al (2018) OnabotulinumtoxinA in chronic migraine: predictors of response. A prospective multicentre descriptive study. Eur J Neurol 25(2):411–416

    CAS  Article  Google Scholar 

  12. 12.

    Reuter U, Goadsby PJ, Lanteri-Minet M, Wen S, Hours-Zesiger P, Ferrari MD et al (2018) Efficacy and tolerability of erenumab in patients with episodic migraine in whom two-to-four previous preventive treatments were unsuccessful: a randomised, double-blind, placebo-controlled, phase 3b study. Lancet 392(10161):2280–2287

    CAS  Article  Google Scholar 

  13. 13.

    Ferrari MD, Diener HC, Ning X, Galic M, Cohen JM, Yang R et al (2019) Fremanezumab versus placebo for migraine prevention in patients with documented failure to up to four migraine preventive medication classes (FOCUS): a randomised, double-blind, placebo-controlled, phase 3b trial. Lancet 394(10203):1030–1040

    CAS  Article  Google Scholar 

  14. 14.

    Mulleners WM, Kim BK, Láinez MJ, Lanteri-Minet M, Aurora SK, Nichols RM et al (2019) A randomized, placebo-controlled study of galcanezumab in patients with treatment-resistant migraine: double-blind results from the CONQUER study. Cephalalgia 39(1S):366

    Google Scholar 

  15. 15.

    Tribl GG, Schnider P, Wober C, Aull S, Auterith A, Zeiler K et al (2001) Are there predictive factors for long-term outcome after withdrawal in drug-induced chronic daily headache? Cephalalgia 21(6):691–696

    CAS  Article  Google Scholar 

Download references


Not applicable.

Author information




RM: patient enrollment, analysis and interpretation of the data, statistical analysis and drafting/revising the manuscript. CPLP: patient enrollment. MF: interpretation of the data and drafting/revising the manuscript. PJG: patient enrollment, study concept, interpretation of the data and drafting/revising the manuscript. He also acted as study supervisor.

Corresponding author

Correspondence to Roberta Messina.

Ethics declarations

Conflicts of interest

R. Messina declares, unrelated to this work, compensation for speaking activities from Novartis, Eli Lilly and Teva Pharmaceutical Industries. C. P. Lastarria Pèrez have no conflict of interest related to the publication of this manuscript. M. Filippi declares, unrelated to this work, compensation for consulting services and/or speaking activities from Bayer, Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme, Takeda, and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, Teva Pharmaceutical Industries, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA). Prof. Filippi is Editor-in-Chief of the Journal of Neurology. P. J. Goadsby reports unrelated to the work, over the last 36 months, grants and personal fees from Amgen and Eli-Lilly and Company, grant from Celgene, and personal fees from Aeon Biopharma, Alder Biopharmaceuticals, Allergan, Autonomic Technologies Inc., Biohaven Pharmaceuticals Inc., Clexio, Electrocore LLC, Epalex, eNeura, Impel Neuropharma, MundiPharma, Novartis, Santara Therapeutics, Teva Pharmaceuticals, Trigemina Inc., WL Gore, and personal fees from MedicoLegal work, Massachusetts Medical Society, Up-to-Date, Oxford University Press, and Wolters Kluwer; and a patent magnetic stimulation for headache assigned to eNeura without fee.

Ethics approval and consent to participate

The audit was registered with the King’s College Hospital Neurology Department Audit Committee.

Consent for publication

Not applicable.

Availability of data and materials

The data that support the findings of this study are available upon reasonable request from the corresponding author.

Code availability

Not applicable.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Messina, R., Lastarria Perez, C.P., Filippi, M. et al. Candesartan in migraine prevention: results from a retrospective real-world study. J Neurol (2020).

Download citation


  • Migraine
  • Candesartan
  • Prevention
  • Treatment response
  • Challenging migraine patients