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Hypertension Drug Eases Migraines

Atacand reduces number, severity of attacks

FRIDAY, Jan. 3, 2003 (HealthDayNews) -- A prescription medicine used to treat high blood pressure also helps prevent migraine headaches, Norwegian researchers report.

The research team used candesartan cilexetil (Atacand), a drug that was approved by the U.S. Food and Drug Administration in 1998, to determine if it could alleviate the migraine headaches of 60 patients, ages 18 to 65, who typically experienced two to six attacks each month.

The researchers randomly assigned 30 patients to take a 16-milligram Atacand every day in the first 12-week treatment period, followed by a placebo pill every day for the second 12-week treatment period. The other 30 people took the placebo first, and then the drug, although they did not know if they were taking medicine or placebo.

During the 12-week periods, the average number of days with headaches was 18.5 with placebo and 13.6 with the medicine, the researchers found. The drug reduced not only the number of headache and migraine days but also the length of the attacks. About 32 percent to 46 percent of the patients responded with at least a 50 percent reduction of one of the outcome measures, such as headache severity.

"In our study, the effect persisted in those responding throughout all months on active medication," says Dr. Erling Tronvik, a neurologist on staff at St. Olavs Hospital in Trondheim, Norway, and the study's lead author. Fifty-seven people completed the entire study.

The medicine studied is known as an angiotensin II receptor blocker. Angiotensin II is a substance that constricts blood vessels and can make blood pressure rise. The authors say they are not certain how it works to reduce or prevent migraine. They evaluated it after learning that another hypertension medicine, the angiotensin-converting enzyme (ACE) inhibitor lisinopril (sold under the brand names Prinivil or Zestril), is also effective as a migraine preventive treatment.

The Norwegian team decided to study Atacand after a colleague in their department noticed his migraines disappeared when he started taking the drug lisinopril for his high blood pressure. Tronvik and his colleagues reasoned that if the anti-migraine effect was linked to the lisinopril, which reduces the amount of angiotensin II, a drug such as Atacand, which works by blocking angiotensin II, might be even more effective.

The latest study appears in the current issue of the Journal of the American Medical Association. The researchers conclude that Atacand might be useful to prevent migraines but say more, larger studies are needed. The drug's manufacturer, AstraZeneca, provided medication and financial support for the study.

"We have no predictors [as] to who might respond to this type of medication," Tronvik says. "But this is something we are currently investigating, both with respect to blood pressure variations and to genetic variations."

Up to 240 million people worldwide suffer 1.4 billion migraine attacks yearly, according to the authors. In the United States, about 28 million suffer from migraines, according to the American Medical Association. Existing medications give some relief, but don't help everyone. Experts are always searching for more medicines to prevent the attacks.

Migraines typically involve intense throbbing pain, sometimes accompanied by visual disturbances as well as sensitivity to light and sounds.

The study is termed "interesting" by another expert, Dr. Andrew K. Oh, a neurologist at the Santa Monica-UCLA Medical Center and an assistant clinical professor of neurology at the David Geffen School of Medicine at the University of California at Los Angeles.

But he adds that several other drugs meant for other purposes have now been proven to work to prevent migraine. "This is sort of a 'Me, too' type of paper," he says.

If a migraine patient who knew of the study asked his advice, Oh says he would say that "the drug has been proven in this small study to be effective. You might want to consider trying it." Or, he adds, the patient might want to try other drugs that have been shown to prevent migraines, since many of them are less expensive than the one studied here.

Exactly how the medicine works isn't known, Oh agrees. "Presumably it has multiple effects on multiple sites in the brain," Oh says.

What To Do

For more information on migraines, click on MAGNUM or the National Institutes of Neurological Disorders and Stroke.

SOURCES: Andrew K. Oh, M.D., assistant clinical professor or neurology, UCLA David Geffen School of Medicine, and staff neurologist, Santa Monica-UCLA Medical Center, Los Angeles; Erling Tronvik, M.D., department of neurology and clinical neurophysiology, St. Olavs Hospital, Trondheim, Norway; Jan. 1, 2003, Journal of the American Medical Association
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