Angiotensin Receptor Blockers and ACE Inhibitors for Migraine Prophylaxis - A Systematic Review

Objective: This was a systematic review of the efficacy of angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARB) for prophylactic treatment of adults with chronic migraine. Background: ACE Inhibitors and ARBs have shown remarkable promise as safe and effective alternatives to FDA-approved agents for migraine prophylaxis. Proposed mechanisms include effects on neurovascular coupling, sympathetic tone, vasoconstriction, promotion of breakdown of proinflammatory markers and modulation of nociception. The low side effect profile and lower cost make these medicines an attractive alternative for chronic migraine sufferers. Design/Methods: Randomized trials and meta-analyses of ACE inhibitors and ARB’s for the prevention of migraine headaches in adults 18–70 years old were identified using PubMed, MEDLINE, Embase, and the Cochrane Library (October 2007 – October 2017). Keywords included: Migraine, renin-angiotensin aldosterone, ACE inhibitor, angiotensin-converting enzyme inhibitor, quinapril, perindopril, ramipril, captopril, enalapril, lisinopril, benazepril, fosinopril, angiotensin receptor blocker, ARB, angiotensin II receptor antagonist, candesartan, cilexetil, irbesartan, olmesartan, valsartan, losartan, azilsartan, medoxomil, telmisartan, and eprosartan. Trials were excluded if they had fewer than 20 participants or if they included patients with diagnosis of cluster or tension headaches. Results: Three randomized trials and one meta-analysis met inclusion criteria. Candesartan significantly reduced migraine days by > 50% in 43% of subjects vs. 23% for placebo (P=0.025). Telmisartan significantly reduced migraine days by 38% vs. 15% for placebo (P=0.0262), but only in post-hoc analyses adjusting for study site. Enalapril significantly reduced migraine frequency from 13 attacks per month to 10 per month (p Conclusions: Lipophilic ACE inhibitors and ARB’s are effective prophylactic agents for reduction of migraine frequency in adults. Disclosure: Dr. Dorosh has nothing to disclose. Dr. Ryon has nothing to disclose. Dr. Ganzer has nothing to disclose. Dr. Seifan has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Honeybrains, LLC.