Candesartan in the prevention of migraine

Candesartan is the most studied angiotensin receptor blocker in the role as a migraine prophylaxis (1):

• data from 2 randomised controlled trials suggest that around 40% of patients taking 16 mg per day of candesartan will have a clinically significant reduction in their number of headache days per month
• candesartan for migraine prophylaxis has several advantages:
  • typically well tolerated, although it does require monitoring of electrolyte levels, serum creatinine level, and hypotensive symptoms
  • an excellent option for patients who have additional comorbidities such as hypertension, cardiovascular disease, or chronic kidney disease
• may not be as effective as other first-line options such as amitriptyline or metoprolol (although data from head-to-head trials are sparse)

A study (n=534) found candesartan 16mg daily resulted in reduction in the mean number of migraine days by weeks 9–12 (from baseline of 5.7 days) compared to placebo (decrease of 2.04 days vs 0.82 days; difference –1.22 [95% CI –1.75 to –0.70]; p<0.0001) and was well tolerated (2).

Reference:

1. Crawley A, Myers J, Regier LD. Clinical pearls for management of migraines. Can Fam Physician. 2024 May;70(5):325-327.
2. OIe RL et al. Candesartan versus placebo for migraine prevention in patients with episodic migraine: a randomised, triple-blind, placebo-controlled, phase 2 trial. Lancet Neurology 2025; 24 (10): 817-27.