Drugs Can Sometimes Prevent Migraines, at a Cost
Study finds many have side effects so bothersome that sufferers stop taking them
The new research was published online in the April issue of the Journal of General Internal Medicine. Out of an initial group of more than 5,000 studies related to preventing migraines, the researchers found 215 publications that involved randomized clinical trials -- considered the gold standard in research -- and 76 publications of non-randomized studies. The researchers reported that most trials were funded by industry and did not disclose conflicts of interest by study investigators.
Most of the studies were conducted in the United States and Western countries, and enrolled mostly middle-aged women with episodic migraines. Participants were mostly overweight and had an average of five migraine attacks a month. Shamliyan noted that many of the studies failed to control for key factors, such as the severity of the headaches, the presence of other health conditions in those studied, other migraine treatments being used, family history, and social and economic status.
Based on their analysis of the studies, the researchers concluded that approved drugs and off-label angiotensin-inhibiting drugs (lisinopril, captopril and candesartan), or off-label beta blockers (metoprolol, acebutolol, atenolol and nadolol) were effective in preventing episodic migraines in adults.
Off-label angiotensin-inhibiting drugs showed the most favorable combination of benefits to potential harms. The U.S. Food and Drug Administration permits physicians to prescribe approved medications for purposes other than their intended indications, and that practice is known as off-label use.
The study also found that there's a lack of research available about the long-term effects of drug treatments, especially on quality of life.
In treating migraines, off-label medications are frequently used, said Rosenberg. "In my practice I'm prescribing off-label as much as on-label." This, while state-of-the-art, should be a call to action, he added. "It's totally unacceptable that all the drugs we're using were invented for other diseases."