From the Guidelines
Beta-blockers, such as propranolol, and angiotensin II receptor blockers, like candesartan, are indicated for migraine prevention, including headache treatment, as supported by recent guidelines 1. When considering antihypertensive medications for headache treatment, it's crucial to prioritize those with evidence supporting their use in migraine prevention.
- Key considerations include:
- The use of beta-blockers, such as propranolol, which have been suggested for migraine prevention 1.
- Angiotensin II receptor blockers, like candesartan, also recommended for preventive treatment of episodic migraine 1.
- Lisinopril, an angiotensin-converting enzyme inhibitor, is suggested for the prevention of episodic migraine, although the recommendation is weaker 1. The choice of medication should be tailored to the individual patient, taking into account their specific health conditions, potential side effects, and the strength of evidence supporting the use of each medication for migraine prevention.
- Important factors to consider when prescribing these medications include:
- Starting with a low dose and gradually increasing as needed and tolerated.
- Monitoring for side effects, such as fatigue, dizziness, and cold hands and feet, which are common with beta-blockers.
- Ensuring the patient is aware of the potential benefits and risks associated with using antihypertensive medications for headache treatment. Given the most recent and highest quality evidence, candesartan is recommended for the prevention of episodic migraine, making it a suitable option for headache treatment in appropriate patients 1.
From the FDA Drug Label
Migraine: Propranolol hydrochloride extended-release capsules are indicated for the prophylaxis of common migraine headache The antihypertensive medication indicated for migraine prophylaxis is propranolol 2.
- Key points:
- Propranolol is used for the prophylaxis of common migraine headache.
- It is not indicated for the treatment of a migraine attack that has already started.
From the Research
Antihypertensive Medications for Headache Treatment
- The use of blood pressure-lowering drugs has been shown to prevent a significant proportion of headaches 3
- A meta-analysis of 94 randomized placebo-controlled trials found that one third fewer people on average reported headache in the treated groups compared to the placebo groups 3
- The prevalence of headache was reduced in trials of each of the 4 classes of drugs, including thiazides, beta-blockers, ACE inhibitors, and angiotensin II receptor antagonists 3
Specific Antihypertensive Medications for Migraine Prevention
- A systematic review and meta-analysis found that several blood pressure-lowering medications, including alpha-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, and calcium channel blockers, reduced monthly headache days in participants with episodic migraine 4
- Specific drugs that were found to be effective in reducing headache frequency include clonidine, candesartan, atenolol, bisoprolol, metoprolol, propranolol, timolol, nicardipine, and verapamil 4
Diagnosis and Treatment of Headaches
- Headaches are common in primary care and can be diagnosed through a careful history and physical examination 5
- Preventive treatment is indicated for frequent headaches, and successful treatment entails low-dose medication with careful titration and monitoring of headache frequency 5
Relationship Between Blood Pressure and Headache
- Mild or moderate chronic arterial hypertension does not appear to cause headache, and there is little evidence that it predisposes patients to headache 6
- Headaches are associated with abrupt, severe, and paroxysmal elevations in blood pressure, such as those seen in pheochromocytoma, hypertensive crisis, and pre-eclampsia 6
- A study found that headache in patients with mild to moderate hypertension is generally not associated with simultaneous blood pressure elevation 7