From the Guidelines
Amlodipine is not recommended as a first-line treatment for migraine prophylaxis due to limited evidence supporting its effectiveness for this purpose. The most recent and highest quality study, 1, does not mention amlodipine as a treatment option for migraine prophylaxis, instead focusing on established treatments such as b-blockers, anticonvulsants, and antidepressants.
Key Points to Consider
- First-line preventive medications for migraines include propranolol (40-240 mg daily), topiramate (25-100 mg twice daily), amitriptyline (10-150 mg at bedtime), or valproate (500-1000 mg daily) as stated in 1.
- Calcium channel blockers have been used for migraine prevention, but amlodipine specifically has limited evidence supporting its effectiveness for this purpose.
- The mechanism behind calcium channel blockers' potential benefit in migraine prevention involves their ability to inhibit cortical spreading depression and reduce cerebral vasospasm, but amlodipine's vascular selectivity may make it less effective for neurological conditions compared to other calcium channel blockers that cross the blood-brain barrier more readily.
Alternative Treatment Options
- CGRP antagonists like erenumab, fremanezumab, or galcanezumab are newer effective options for patients who fail traditional preventives.
- Nondrug treatments, such as cognitive-behavioral therapy (CBT) and biofeedback, may also be considered as part of a comprehensive treatment plan, as mentioned in 1.
Clinical Decision Making
- Patients should try established preventive medications before considering alternative options like amlodipine for migraine prophylaxis.
- When a single agent does not sufficiently improve both the migraine and the comorbid disorder, polytherapy should be considered, as stated in 1.
From the Research
Amlodipine for Migraine Prophylaxis
- Amlodipine is a calcium-channel blocker that has been used for migraine prophylaxis, as reported in a study published in 1998 2.
- The study found that amlodipine was effective in treating two patients with migraine, suggesting its potential as a prophylactic medication for migraine.
- However, amlodipine is not listed as a first-choice medication for migraine prophylaxis in a 2010 study 3, which recommends beta-blockers, flunarizine, topiramate, valproate, and amitriptyline as the primary options.
- Calcium-channel blockers, including amlodipine, are mentioned as potential prophylactic medications for migraine in a 1988 study 4, but their use is not extensively discussed in the context of migraine treatment.
Efficacy and Safety of Amlodipine
- Amlodipine has been shown to be effective and safe in the treatment of hypertension, with strong evidence from large randomized controlled trials for cardiovascular event reduction 5.
- A 2025 study suggests that S-amlodipine, a stereoisomer of amlodipine, may be a better option for hypertension treatment due to its improved efficacy and reduced side effects, such as pedal edema 6.
- However, the studies on amlodipine's efficacy and safety are primarily focused on its use in hypertension treatment, and more research is needed to fully understand its potential as a migraine prophylaxis medication.