TY - JOUR
T1 - The effect of blood pressure lowering medications on the prevention of episodic migraine
T2 - a systematic review and meta-analysis
AU - Carcel, Cheryl
AU - Haghdoost, Faraidoon
AU - Shen, Joanne
AU - Nanda, Puneet
AU - Bai, Yu
AU - Atkins, Emily
AU - Torii-Yoshimura, Takako
AU - Clough, Alexander J.
AU - Davies, Leo
AU - Cordato, Dennis
AU - Griffiths, Lyn R.
AU - Balicki, Grace
AU - Wang, Xia
AU - Vidyasagar, Kota
AU - Malavera, Alejandra
AU - Anderson, Craig S.
AU - Zagami, Alessandro S.
AU - Delcourt, Candice
AU - Rodgers, Anthony
N1 - Copyright the International Headache Society 2023. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - Background: Currently, only a few specific blood pressure-lowering medications are recommended for migraine prevention. Whether benefits extend to other classes or drugs is uncertain. Methods: Embase, MEDLINE, and the Cochrane Central Registry of Controlled Trials were searched for randomized control trials on the effect of blood pressure-lowering medications compared with placebo in participants with episodic migraine. Data were collected on four outcomes - monthly headache or migraine days, and monthly headache or migraine attacks, with a standardised mean difference calculated for overall. Random effect meta-analysis was performed. Results: In total, 50 trials (70% of which were crossover) were included, comprising 60 comparisons. Overall mean age was 39 years, and 79% were female. Monthly headache days were fewer in all classes compared to placebo, and this was statistically significant for all but one class: alpha-blockers -0.7 (95% CI: -1.2, -0.1), angiotensin-converting enzyme inhibitors -1.3 (95% CI: -2.9, 0.2), angiotensin II receptor blockers -0.9 (-1.6, -0.1), beta-blocker -0.4 (-0.8, -0.0) and calcium channel blockers -1.8 (-3.4, -0.2). Standardised mean difference was significantly reduced for all drug classes and was separately significant for numerous specific drugs: clonidine, candesartan, atenolol, bisoprolol, metoprolol, propranolol, timolol, nicardipine and verapamil. Conclusion: Among people with episodic migraine, a broader number of blood pressure-lowering medication classes and drugs reduce headache frequency than those currently included in treatment guidelines. Trial Registration: The study was registered at PROSPERO (CRD42017079176).
AB - Background: Currently, only a few specific blood pressure-lowering medications are recommended for migraine prevention. Whether benefits extend to other classes or drugs is uncertain. Methods: Embase, MEDLINE, and the Cochrane Central Registry of Controlled Trials were searched for randomized control trials on the effect of blood pressure-lowering medications compared with placebo in participants with episodic migraine. Data were collected on four outcomes - monthly headache or migraine days, and monthly headache or migraine attacks, with a standardised mean difference calculated for overall. Random effect meta-analysis was performed. Results: In total, 50 trials (70% of which were crossover) were included, comprising 60 comparisons. Overall mean age was 39 years, and 79% were female. Monthly headache days were fewer in all classes compared to placebo, and this was statistically significant for all but one class: alpha-blockers -0.7 (95% CI: -1.2, -0.1), angiotensin-converting enzyme inhibitors -1.3 (95% CI: -2.9, 0.2), angiotensin II receptor blockers -0.9 (-1.6, -0.1), beta-blocker -0.4 (-0.8, -0.0) and calcium channel blockers -1.8 (-3.4, -0.2). Standardised mean difference was significantly reduced for all drug classes and was separately significant for numerous specific drugs: clonidine, candesartan, atenolol, bisoprolol, metoprolol, propranolol, timolol, nicardipine and verapamil. Conclusion: Among people with episodic migraine, a broader number of blood pressure-lowering medication classes and drugs reduce headache frequency than those currently included in treatment guidelines. Trial Registration: The study was registered at PROSPERO (CRD42017079176).
KW - Antihypertensive medication
KW - blood pressure
KW - migraine
KW - prevention
KW - randomized trials
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85162745666&partnerID=8YFLogxK
U2 - 10.1177/03331024231183166
DO - 10.1177/03331024231183166
M3 - Review article
C2 - 37350141
SN - 0333-1024
VL - 43
SP - 1
EP - 9
JO - Cephalalgia
JF - Cephalalgia
IS - 6
ER -