The Pharmaceutical Journal
Vol 270 No 7231 p42
11 January 2003

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Candesartan could help in preventing migraines

Candesartan (Amias) could prove to be an effective agent for migraine prophylaxis, according to the results of a small placebo-controlled study.

The researchers say that the response rate, lack of side effects and absence of drug interactions mean that the angiotensin II receptor antagonist warrants further study in a larger trial. In all, 60 patients aged 18 to 65 years who suffered between two and six migraine attacks per month were randomised to receive either candesartan 16mg or placebo for 12 weeks after a four-week placebo run-in phase. Then, after a second four-week period on placebo, the two groups had their therapies switched for a further 12 weeks.

The main study end point was number of days with headache. Secondary end points included the number of hours with headache, days when migraine was present, total hours with migraine, severity of headache, disability, number of doses of triptans and analgesics, and acceptability of treatment.

On average patients treated with candesartan had 4.9 fewer days with headache than placebo-treated patients (18.5 vs 13.6, P=0.001). Candesartan-treated patients also experienced 36 per cent fewer hours with migraine compared with placebo-treated patients. Headache severity was also reduced among the candesartan group compared with placebo.

Between 32 and 46 per cent of patients responded to candesartan treatment, defined as at least a 50 per cent reduction on at least one of the efficacy outcomes. Although no mode of action for candesartan as a migraine prophylactic has been proven, the researchers say blocking angiotensin II has several effects relevant to migraine. These include direct vasoconstriction, increased sympathetic discharge and release of adrenal medullary catecholamine.

However, the characteristics of the drug itself "may make it suitable as a migraine prophylactic drug", they write. "In this study the incidence of adverse effects attributable to candesartan was similar to that for placebo, and it has no significant drug interactions," comment the authors.

They add that candesartan does not affect pulse rate and can safely be used in patients with asthma (JAMA 2003;289:65).