Blood pressure lowering medications could be used more widely to prevent migraines

Reviewed by Danielle Ellis, B.Sc.Jun 27 2023

The first known large-scale review of international studies on the positive effect of blood pressure (BP) medicines across all classes in preventing migraine shows these widely available drugs could be used much more widely, at low cost, than is the case with current practice, according to a new paper published today in the journal, Cephalalgia.

Conducted by researchers at The George Institute for Global Health in Sydney, Australia, the study confirms almost all classes of antihypertensive medications have some ability to reduce the frequency of days with headache in people with migraine and that more research is therefore warranted to better understand the mechanisms involved.

The meta-analysis included 50 trials of more than 4,300 people, with BP-lowering medication on average reducing the number of headache days experienced per month by about one (1) day on top of the average placebo effect.

For countries where new migraine medications are expensive, limited by prescribing criteria or not available at all – covering all countries to some extent - this study shows that common BP medicines, which GPs are comfortable prescribing, can be an important preventative measure for patients with migraine or severe headache episodes,”

Dr Cheryl Carcel, Study’s Joint Principal Investigator, Senior Research Fellow, The George Institute and Conjoint Senior Lecturer, Faculty of Medicine, UNSW Sydney.

“Moreover, while we can see from the analysis that the effect is true for almost all types of BP medicines, this is not reflected in the current clinical guidelines, which specify just one or two types (such as beta-blockers) but not the full range of therapies that could be useful,” she said.

Global migraine prevalence is estimated at 14 to 15 per cent of the population, representing a major cause of ill health for up to 1 billion people.  According to the World Health Organisation, headache disorders, of which migraine is one, are the world’s second leading cause of disability overall and the first among women.

Around 90 percent of people with migraine can be managed in general practice, where the goal is to prevent as many episodes as possible because of the disabling impact they have on the patient’s quality of life. The good news is that blood pressure medications are widely available at low cost, with many available in generic forms, presenting a trusted treatment option alongside other preventive measures such as avoiding triggers and making lifestyle changes.”

Dr Faraidoon Haghdoost, Joint Principal Investigator and Former GP. 

The results also indicated that not all BP medications are equally effective in preventing migraine. The George Institute team is soon to publish a further review to give more insight into which of the various mechanisms are best.

“The numbers of people living with headache disorders is enormous and common treatments given once an episode has taken hold can have side effects that in themselves present problems, such as drowsiness or weight gain,” continued Dr Haghdoost. “Whereas BP meds can prevent episodes without a significant side effect burden.”