The effect of blood pressure lowering medications on the prevention of episodic migraine: A systematic review and meta-analysis
Cheryl Carcel, Faraidoon Haghdoost, Joanne X. 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, Anthony Rodgers
Abstract
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: The study was registered at PROSPERO (CRD42017079176).