High Blood Pressure Support Group
Hypertension or high blood pressure is a medical condition wherein the blood pressure is chronically elevated. Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysm, and is a leading cause of chronic renal failure. Doctors recommend weight loss and regular exercise as the first steps in treating mild to moderate...
I am not sure whether I mentioned this before, but first lisinopril (which gave me a cough), and now candesartan (which gives me no side effects), have, coincidentally, really helped with my migraines. I have far, far fewer than I used to have, and those I do have tend to be less severe.
I wondered whether I had just grown out of the migraines, but recntly for a couple of months I went off candesartan for a doctor-suggested experiment with twice-daily losartan, and my migraines started to come back.
Back on candesartan now, and my head is clear as anything!
I just thought I would mention this in case anyone else out there suffers from migraines too.
John
I wondered whether I had just grown out of the migraines, but recntly for a couple of months I went off candesartan for a doctor-suggested experiment with twice-daily losartan, and my migraines started to come back.
Back on candesartan now, and my head is clear as anything!
I just thought I would mention this in case anyone else out there suffers from migraines too.
John
Trondheim, Norway - Results of a randomized trial suggest that the angiotensin II receptor blocker candesartan (Atacand - AstraZeneca) may provide effective prophylaxis against migraine headaches. The new report from Norwegian researchers appears in the January 1, 2003 issue of the Journal of the American Medical Association.1
"In our study, candesartan reduced the number of headache days, migraine days, and migraine hours compared with placebo, and 32% to 46% of patients were responders with at least a 50% reduction on at least 1 of the efficacy outcomes," the authors, led by Dr Erling Tronvik (St Olavs Hospital, Trondheim, Norway) write.
"Our findings suggest that the angiotensin II receptor blocker candesartan might be a useful agent for migraine prophylaxis," they conclude. Larger studies to confirm these findings are warranted.
Treatment vs prevention
While treatment of migraines has recently been improved with the introduction of a group of drugs dubbed triptans, the authors write, only 50% to 60% of patients respond to these medications, and many have only partial relief. Prophylaxis of migraines has been achieved with calcium channel blockers, anticonvulsants, and antidepressant agents, as well as with beta blockers and ACE inhibitors, Tronvik and colleagues write. One paper published in January of 2001 by Dr Harald Schrader and colleagues from Tronvik's institution showed lisinopril was an effective prophylactic treatment in patients with frequent migraines.2 However, side effects of these medications in an otherwise healthy population, including pulse rate changes and sexual dysfunction for beta blockers and cough with ACE inhibitors might limit their long-term use, the authors write.
Because of the effects seen with lisinopril, the investigators reasoned that candesartan might also provide this benefit with fewer side effects. While its mechanism in preventing migraine is not clear, there are several effects that may be relevant to migraine, including direct vasoconstriction, increased sympathetic discharge, and adrenal medullary catecholamine release, Tronvik et al write.
Recent work has also shown the ACE-DD gene polymorphism could have an important role in determining migraine attacks and their frequency, Tronvik told heartwire, supporting possible involvement of the renin-angiotensin system in migraine.
After encouraging early work, they undertook the current study, a randomized, controlled, crossover study including 60 patients seen at their neurological outpatient clinic. Eligible patients had 2 to 6 migraine attacks per month.
The study design allowed for a 4-week placebo run-in period, followed by 2 treatment periods of 12 weeks each, separated by 4 weeks of placebo washout. Half the patients received a daily 16-mg candesartan tablet followed by placebo, half received placebo first followed by candesartan.
The primary end point was the number of days with headache; secondary end points included hours with headache, days with migraine, hours with migraine, headache severity index, level of disability, doses of triptans, doses of analgesics, acceptability of treatment, days of sick leave, and quality of life measured using the Short Form 36 questionnaire.
Both primary and most secondary end points were significantly reduced by candesartan treatment. Only quality-of-life measures did not reach statistical significance.
Migraine reduction with candesartan vs placebo over 12 weeks
End points
Candesartan
Placebo
p
Headache days (primary end point)
13.6
18.5
0.001
Headache hours
95.0
139.0