An arsenal of medications is available for migraine sufferers, which can be divided into 2 broad categories: drugs for treatment--such as pain relievers and "triptan" drugs; and drugs for prevention--which include some of the same medications used to treat high blood pressure. According to 2002 guidelines developed by the American College of Physicians, the American Society of Internal Medicine and the American Academy of Family Physicians, preventative therapy is warranted for patients having migraines two or more times per month, severe migraine symptoms three or more days per month, those who use medicine for migraines more than twice per week or for whom medicine does not relieve migraines, and those whose migraines are complicated by neurologic symptoms.
Beta-Blockers
A class of drugs known as beta-blockers has been well-studied and found to be safe and effective for the prevention of migraines. Beta-blockers are prescription medications commonly used to treat high blood pressure, angina, fast heart rates and congestive heart failure. Many beta-blockers are available, but those most commonly used for migraine prevention are atenolol, metoprolol, nadolol, propranolol, and timolol, the last two of which are FDA-approved for this use. Beta-blockers are particularly appropriate therapy for migraine prevention in people also having high blood pressure or another condition that may also be helped by this class of drugs. Beta-blockers are generally well tolerated, but patients with asthma, diabetes, or heart conditions associated with slow heart rates should use caution.
ACE Inhibitors and ARBS
Two other classes of drugs commonly used to lower blood pressure may be beneficial for migraine prevention, though the data are less convincing than that for the beta-blockers. Angiotensin-converting enzyme (ACE) inhibitors such as lisinopril and angiotensin receptor blockers (ARBs) like candesartan and telmisartan were found to modestly reduce the duration of migraines in a study conducted by Gales and colleagues published in February 2010. Though also well tolerated, these drugs are generally not among the first to be tried for migraine prevention due to fewer studies and limited efficacy compared to the beta-blockers
Calcium Channel Blockers
Calcium channel blockers are also used for lowering blood pressure and have been evaluated in a few studies for prevention of migraine. According to 2002 guidelines published in the "Annals of Internal Medicine," these agents are only modestly effective and are not first-line agents. Such medications include verapamil, nifedipine, and nimodipine
References
- "Pharmacotherapy: A Pathophysiologic Approach"; DiPiro JT, Talbert RL, Yee, GC, et al, editors, 2005. Chapter 59 "Headache Disorders", King DS, Herndon KC.
- Snow V, Weiss, K, Wall EM, et al. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. Ann Intern Med 2002;137(10):840-9.
- Gales BJ, Bailey EK, Reed AN, et al. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for the prevention of migraines. Ann Pharmacotherapy 2010;44(2):360-6.
