Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) may represent effective prophylactic treatments in populations with co-morbidities such as hypertension. Some mechanisms include promotion of vasoconstriction and reduction in pro-inflammatory cytokine levels.
Preclinical studies suggest that there is a tissue-based renin-angiotensin system present in the brain and that this system plays a role in the relay of nociceptive signals, neurogenic inflammation, endothelial dysfunction, and oxidative stress. While not confirmed yet in humans, it is hypothesized that these factors may play a role in the pathogenesis of migraine.
Many studies support the hypothesis that migraine patients have an increased risk of developing hypertension, while hypertensive subjects do not seem to have an increased risk of migraines or other types of headaches. (Finochi et at, 2017) Emerging medications such as ACE inhibitors, sartans, and nutritional supplements are gaining favor for migraine prophylaxis. (Barbanti et al, 2011)
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Rau JC, Dodick DW. Other Preventive Anti-Migraine Treatments: ACE Inhibitors, ARBs, Calcium Channel Blockers, Serotonin Antagonists, and NMDA Receptor Antagonists. Curr Treat Options Neurol. 2019 Mar 18;21(4):17. doi: 10.1007/s11940-019-0559-0. PMID: 30880363.
Finocchi C, Sassos D. Headache and arterial hypertension. Neurol Sci. 2017 May;38(Suppl 1):67-72. doi: 10.1007/s10072-017-2893-x. PMID: 28527058.
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