Purpose of Review

Systematic review of angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARB) in the prophylactic treatment of adults with migraine. To identify gaps in research and provide guidance for future clinical trials.

Recent Findings

A search was completed using PubMed, MEDLINE, Embase, and the Cochrane Library January 1, 1990 through December 31, 2017. The following are keywords used in the search: migraine, migraine prophylaxis/prevention, renin-angiotensin-aldosterone system, RAAS, ACE inhibitors, angiotensin-converting enzyme inhibitors: quinapril, perindopril, ramipril, captopril, enalapril, lisinopril, benazepril, fosinopril. Angiotensin receptor blockers, ARB, angiotensin II receptor antagonists: candesartan cilexetil, irbesartan, olmesartan, valsartan, losartan, azilsartan medoxomil, telmisartan, and eprosartan. The search included randomized controlled trials (RCT), systemic reviews and open-label studies of ACE inhibitors and ARB for the prevention of migraine attacks in adults 18–70 years old. Of 2461 retrieved articles, 18 included RCT, meta-analysis, systemic reviews, or guidelines published on ACE inhibitors or ARB in the prevention of migraine. Three RCT with telmisartan 80 mg, candesartan 16 mg, and enalapril 10 mg, and two open-label trials with lisinopril 5 mg and ramipril 5 mg found a high number of responders with greater than 50 % reduction in migraine attack frequency when compared to a 4-week baseline period. Candesartan was superior to placebo while telmisartan and enalapril were not.

Summary

Lipophilic ACE inhibitors and ARBs can be effective prophylactic agents for reduction of migraine frequency in adults. Based on the limited number of published trials and small sample size, they are not recommended as first-line prophylactic agents. However, in populations with co-morbidities such as hypertension, they may be useful as first- or second-line prophylactics. Additional trials following the International Headache Society’s guidelines on RCT are warranted.

中文翻译：

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血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂在成人发作性偏头痛的预防性治疗中的功效。

审查目的

对成人偏头痛的预防性治疗中血管紧张素转化酶抑制剂（ACE抑制剂）和血管紧张素受体阻滞剂（ARB）的系统评价。查明研究差距并为将来的临床试验提供指导。

最近的发现

使用PubMed，MEDLINE，Embase和Cochrane库完成了搜索，时间为1990年1月1日至2017年12月31日。搜索中使用了以下关键字：偏头痛，偏头痛的预防/预防，肾素-血管紧张素-醛固酮系统，RAAS， ACE抑制剂，血管紧张素转化酶抑制剂：奎那普利，培哚普利，雷米普利，卡托普利，依那普利，赖诺普利，贝那普利，福辛普利。血管紧张素受体阻滞剂，ARB，血管紧张素II受体拮抗剂：坎地沙坦cilexetil，厄贝沙坦，奥美沙坦，缬沙坦，氯沙坦，阿齐沙坦medoxomil，替米沙坦和依普罗沙坦。搜索内容包括ACE抑制剂和ARB预防18-70岁成人偏头痛发作的随机对照试验（RCT），系统评价和开放标签研究。在2461篇检索的文章中，有18篇包括RCT，荟萃分析，有关预防偏头痛的ACE抑制剂或ARB的系统评价或指南。3例替米沙坦80 mg，坎地沙坦16 mg和依那普利10 mg的RCT，以及2例赖诺普利5 mg和雷米普利5 mg的开放标签试验发现，与安慰剂相比，大量的应答者偏头痛发作频率降低50％以上基线期为4周。坎地沙坦优于安慰剂，而替米沙坦和依那普利则不然。

概要

亲脂性ACE抑制剂和ARBs可以有效降低成人偏头痛的发生率。由于已发表的试验数量有限且样本量较小，因此不建议将它们作为一线预防剂。但是，在患有合并症（例如高血压）的人群中，它们可用作一线或二线预防措施。必须遵循国际头痛协会关于RCT的指南进行其他试验。