Averting Migraines With Few Side Effects

Dec. 31, 2002 -- A member of the newest class of high blood pressure medications may prevent migraines with similar results but fewer side effects than other drugs employed for these crippling headaches, which are suffered by some 240 million people worldwide.

Norwegian researchers say that headache and migraine attacks were cut by nearly half in patients after starting a daily regimen of Atacand, one of six angiotensin II receptor blockers (ARBs) marketed in the U.S. Their study is published in the Jan. 1, 2003, issue of TheJournal of the American Medical Association.

Atacand, which received FDA approval in 1998, is the latest hypertension drug being studied as a preventative treatment for migraine, although how the drug prevents migraines is not known. Beta-blockers such as Inderal and Levatol and ACE inhibitors such as Prinivil or Zestril are also effective, but often with troublesome side effects.

Beta-blockers can cause a range of problems from fatigue to sexual dysfunction and are not recommended for patients with asthma; ACE inhibitors, which are used less frequently in migraine prevention, cause fewer side effects than beta-blockers but produce a nagging dry cough in about 20% of patients and may increase potassium levels in the body to dangerous levels.

"The main advantage of Atacand over beta-blockers would be its improved safety profile, especially since it does not lower pulse frequency, which is a main advantage when used in a younger population," study author Erling Tronvik, MD, tells WebMD. "In our study, Atacand also showed better results in reducing migraine than demonstrated in a study of ACE inhibitors. But it did not produce the same cough side effect."

ACE inhibitors and ARBs -- such as Atacand -- reduce the production of angiotensin, a hormone that causes arteries to narrow.

Migraine is also prevented with epilepsy drugs such as Valproate and antidepressants such as Elavil, Vivactil, and the popular serotonin-reuptake inhibitors such as Prozac and Zoloft. These drugs produce similar reductions in attacks to what was found in Tronvik's study -- but again, with more side effects.

Over-the-counter drugs such as aspirin and Tylenol and prescription "triptan" medications such as Imitrex are used for an acute attack, not prevention, but only about half of patients respond consistently to these medications. "But frequent use of these or other types of analgesics may lead to medication-overuse headache," says Tronvik, of the Institute of Neuroscience and Motion at the Norwegian University of Science and Technology.

His study is among the first to test an ARB's effect on migraine.

"I'm happy -- especially with the promise of no side effects," says Stephen Silberstein, MD, director of the Jefferson Headache Center in Philadelphia. "If this finding is shown to be true in future studies, this might be a reasonable treatment. But we need to see more about it."