Use of migraine prophylaxis medications such as candesartan can reduce need for triptans, a Scandinavian study shows.

Presented at the European Academy of Neurology (EAN) 2019 Congress in Oslo, the analysis was based on data from 277,191 patients with migraine who had a prescription record of using triptans.

Researchers examined the impact of potential prophylaxis medications which were used by 18% of patients. Patients usually tried beta-blockers first (42%), then amitriptyline (33%) and topiramate (21%).

Candesartan/lisinopril and topiramate had the highest proportion of patients achieving a 30% triptan reduction after three months of use (11% and 13% respectively).

However, many of the patients discontinued using migraine prophylaxis drugs. Candesartan/lisinopril had the highest retention rate after 6 and 12 months , whereas more than 60% of patients stopped using topiramate, amitriptyline and valproic acid after six months.

“In this unselected population compromising all patients using triptans in Norway, candesartan/lisinopril and topiramate was the migraine prophylactic with the highest effectivity in unadjusted analyses,” the study authors concluded

Lead researcher Associate Professor Marte-Helene Bjørk, from the University of Bergen, attributed the high discontinuation rates for some migraine prophylactic drugs to the negative side effects of the medication or lack of perceived efficacy.

“Candesartan for migraine should be studied in randomised blinded and controlled studies to increase the evidence of efficacy. It is a promising migraine prophylactic drug which is know to be well tolerated and inexpensive,” she suggested

“For the patient population and for the health economy globally, it is important to increase the number of well tolerated, effective and accessible migraine prophylactics.”