Angiotensin Blockade Agents
In addition to the beta-blockers and calcium channel blockers, a third type of heart drug, angiotensin blockade agents, has also shown great potential in migraine prevention. These drugs include certain angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and a subtype of ARBs known as angiotensin II receptor antagonists.
Angiotensin blockage agents work to balance fluid and electrolyte levels in the blood and are approved and prescribed for use in treating high blood pressure. As such, they may be a good treatment choice for migraineurs who also suffer from hypertension or prehypertension. It's not yet fully understood exactly how these medications work to prevent migraine, but researchers have theorized that it may be related to their ability to block the action of angiotensin II, a chemical that constricts blood vessels.
A 2002 metanalysis published in the American Journal of Medicine found that among the 12,110 patients studied, the risk of headache was one-third lower in those patients taking an angiotensin II receptor antagonist than in those who did not.
In the early 2000s, two separate Norwegian studies found that the ACE inhibitor lisinopril (Zestril) and the ARB candesartan (Atacand) cut total days with migraine by more than half in study subjects. Other studies of the drugs have reached similar conclusions.
The angiotensin II receptor antagonist, olmesartan (Benicar), also showed very promising results in a 2006 U.S. study, with subjects reporting an 82.5 percent reduction in the frequency of their migraines and a 45 percent reduction in migraine severity.
Angiotensin blockade agents seem to have fewer severe side effects than some of the other prophylactic drugs for migraine. Commonly reported side effects are lightheadedness or dizziness, low blood pressure, fatigue, increased blood potassium levels, and a metallic or salty taste in the mouth.
Most people with impaired kidney function or liver disease should avoid angiotensin blockade agents, as should anyone with a known allergy to drugs in this class. Because of their ability to increase potassium levels in the bloodstream, these drugs should not be taken with potassium supplements or foods or medicines that are known to increase potassium (including potassium-fortified salt substitutes). They should also not be used with diuretics.
Some angiotensin blockade agents can increase side effects of the drug lithium, and anyone taking both of these medications should be closely monitored by his physician. These drugs may also interact with other medications; again, always speak with your doctor about possible interactions with your current prescription and supplement regimen.
