Amlodipine and Migraine: Limited Evidence for Prophylactic Benefit
Amlodipine is not recommended as a first-line or standard preventive therapy for migraine, as it lacks robust clinical trial evidence and is not included in major headache treatment guidelines. 1
Position in Migraine Prevention Guidelines
The major headache treatment guidelines do not recommend amlodipine for migraine prophylaxis:
The 2024 VA/DoD Headache Guidelines recommend candesartan or telmisartan (angiotensin receptor blockers) for episodic migraine prevention, but make no mention of calcium channel blockers like amlodipine for this indication. 1
The 2000 U.S. Headache Consortium Guidelines reviewed 45 controlled trials of calcium channel antagonists and found that evidence for verapamil showed significant differences in only two of three placebo-controlled trials, with uncertain relevance due to high dropout rates. The guidelines concluded there is insufficient evidence to recommend calcium channel blockers for migraine prevention. 1
Lisinopril (an ACE inhibitor) receives a "weak for" recommendation for episodic migraine prevention, while amlodipine is notably absent from all guideline recommendations. 1
Evidence from Cardiovascular Guidelines
Amlodipine appears in cardiovascular guidelines exclusively for its approved indications—hypertension, angina, and heart failure—with no mention of migraine prophylaxis:
The 2016 AHA Heart Failure Guidelines note that amlodipine appeared safe in patients with severe heart failure in the PRAISE trial, but this relates solely to cardiovascular outcomes, not headache. 1
The 2007 AHA Hypertension Guidelines discuss amlodipine's role in blood pressure management and note that headache is a common vasodilator adverse effect of dihydropyridine calcium channel blockers. 1
Single Case Report Evidence
One published case report from 2008 described a 64-year-old woman whose migraine frequency decreased from every-other-day attacks to twice monthly after starting amlodipine 2.5 mg/day for hypertension. 2 However:
A single case report provides insufficient evidence to establish efficacy or recommend clinical use. 2
The patient had failed lomerizine (a calcium channel blocker approved for migraine in Japan), raising questions about whether blood pressure control—rather than amlodipine specifically—contributed to improvement. 2
The authors themselves acknowledged that "the underlying mechanisms have not been elucidated." 2
Established First-Line Migraine Preventive Options
For patients requiring migraine prophylaxis, evidence-based first-line options include:
Beta-blockers without intrinsic sympathomimetic activity: propranolol 80–240 mg/day or timolol 20–30 mg/day (strong evidence from multiple RCTs). 1
CGRP monoclonal antibodies: erenumab, fremanezumab, or galcanezumab for episodic or chronic migraine (strong recommendation based on high-quality trials). 1
Topiramate: for episodic and chronic migraine prevention (weak for recommendation). 1
Angiotensin receptor blockers: candesartan or telmisartan for episodic migraine (strong recommendation). 1
Clinical Considerations
If a patient with both hypertension and migraine requires treatment, selecting an antihypertensive with proven migraine prophylactic benefit (candesartan, telmisartan, propranolol, or timolol) is preferable to amlodipine. 1
Amlodipine commonly causes headache as an adverse effect (related to its vasodilatory properties), which could theoretically worsen rather than improve headache disorders. 1, 3, 4
The absence of amlodipine from all major migraine guidelines despite extensive review of calcium channel blocker trials indicates insufficient evidence to support its use for this indication. 1
Common Pitfall to Avoid
Do not prescribe amlodipine specifically for migraine prevention based on a single case report or anecdotal experience when multiple evidence-based alternatives with proven efficacy are available. 1