Different blood pressure-lowering classes (like calcium channel blockers, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and alpha-blockers)  effectively reduced the frequency of headache days per month compared to placebo in episodic migraine, as deciphered from a recent systematic review and meta-analysis. The objective of the researchers was to assess how antihypertensives influence the prophylaxis of episodic migraine.

For searching randomized controlled trials investigating the impact of blood pressure-lowering medications versus placebo among individuals with episodic migraines, databases such as the Cochrane Central Registry of Controlled Trials, MEDLINE, and Embase were explored. Information was gathered on 4 endpoints: monthly migraine or headache days, and monthly migraine or headache attacks. A standardized mean difference was computed overall. A random-effects meta-analysis was subsequently carried out.

A total of 50 trials (70% of which employed a crossover design) were incorporated, making up 60 different comparisons. The mean age across all trials was 39 years, and 79% of the subjects were female. As found, monthly headache days were fewer in comparison to placebo across all medication classes, with statistical significance observed for all classes like calcium channel blockers (-1.8), beta-blockers (-0.4), angiotensin II receptor blockers (-0.9), angiotensin-converting enzyme inhibitors (-1.3), and alpha-blockers (-0.7) except 1 class.

The standardized mean difference exhibited a significant reduction across all categories of drug classes, and it was also profound for various specific medications: Verapamil, Nicardipine, Timolol, Propranolol, Metoprolol, Bisoprolol, Atenolol, Candesartan, and Clonidine. In individuals battling episodic migraine, a wider range of blood pressure-lowering medication classes and drugs exhibit the capability to minimize headache frequency compared to those currently outlined in treatment guidelines.