Large-scale review reveals untapped potential of blood pressure medications in migraine prevention

In an large-scale review recently published in Cephalalgia, researchers found that a broader range of blood pressure (BP) medications could be leveraged more efficiently than currently practiced to prevent migraines. The study underlines the untapped potential of these common and cost-effective drugs in migraine prevention, a condition affecting up to 1 billion people worldwide.

Migraine has a global prevalence of approximately 14-15% of the population. While BP-lowering medications, such as beta-blockers and angiotensin II receptor blockers (ARBs), are suggested by guidelines for migraine prevention, the available literature is scarce regarding the efficiency of all classes of BP-lowering medications or combination agents in preventing migraines.

This study sought to evaluate the effect of various classes of antihypertensive medications, including alpha-blockers, ARB, angiotensin-converting enzyme inhibitors, beta-blockers, and calcium channel blockers on episodic migraine prevention.

“One in every seven people experiences migraine,” said study author Faraidoon Haghdoost, a research fellow in headache disorders at The George Institute for Global Health at the University of New South Wales.

“It is the leading cause of disability in females aged under 50 and second in all ages and genders. We need more treatment options for the management of migraine. While some blood pressure lowering medications are already included in treatment guidelines for migraine prevention, what about the rest of these medications? Are they effective too? I‘m interested in finding answers to these questions.”

The researchers conducted a systematic review and meta-analysis involving more than 4,300 individuals from 50 scientific trials. Given that prior studies might have had small sample sizes, variable methodologies, or focused on specific drugs within these classes, a meta-analysis allowed them to pool data from diverse studies, improve statistical power, resolve potential discrepancies, and provide a more comprehensive and generalizable understanding of the topic.

The majority of the trials included in the meta-analysis (70%) had a cross-over design, and the overall mean age of participants was 39, with a significant female representation (79%). The study examined a broad array of BP-lowering medications, with a variety of different drugs represented within each class.

The researchers found that, on average, BP-lowering medications could reduce the number of headache days experienced per month by approximately one day, in addition to the average placebo effect.

The research revealed that almost all classes of antihypertensive medications demonstrated some degree of efficacy in reducing headache frequency in people with migraine. This result was statistically significant for all classes and separately significant for several specific drugs within the classes, including clonidine, candesartan, atenolol, bisoprolol, propranolol, timolol, nicardipine, and verapamil.

“Almost all classes of blood pressure lowering medications are useful for the prevention and management of migraine,” Haghdoost told PsyPost. “These medications are globally available, affordable and have few side effects.”

The study’s inclusivity marks a significant contribution to the understanding of the effects of BP-lowering medications in managing episodic migraines. Nonetheless, the researchers highlighted several limitations, including a small sample size for all classes except BBs and the age of many of the studies, which didn’t adhere to current guidelines. Other concerns included inconsistent definitions of outcomes and differences in reported endpoints across studies.

“Our study is a review of previous published papers on the topic. We found that most of the studies assessing the effect of blood pressure lowering medications on migraine are old with very small sample sizes. We need more studies with larger sample sizes that are based on currently accepted methods of evaluating migraine medications,” Haghdoost said.

“We are working on more studies to understand the potential mechanisms for the effect of blood pressure lowering medications on migraine and headache. We would like to know if reducing blood pressure is the reason for this effect.”

Despite these limitations, the study provides valuable insights into the possible role of BP-lowering medications in preventing migraines, at least in episodic migraine patients.

Cheryl Carcel, the study’s Joint Principal Investigator, emphasized the practical implications of the study, especially for countries where newer migraine medications might be expensive, restricted, or unavailable. The research suggests that common BP medications, which general practitioners are comfortable prescribing, could serve as an important preventive measure for patients with migraines or severe headache episodes.

The study, “The effect of blood pressure lowering medications on the prevention of episodic migraine: A systematic review and meta-analysis“, was authored by Cheryl Carcel, Faraidoon Haghdoost, Joanne Shen, Puneet Nanda, Yu Bai, Emily Atkins, Takako Torii-Yoshimura, Alexander J. Clough, Leo Davies, Dennis Cordato, Lyn R. Griffiths, Grace Balicki, Xia Wang, Kota Vidyasagar, Alejandra Malavera, Craig S. Anderson, Alessandro S. Zagami, Candice Delcourt, and Anthony Rodgers.