How effectively do ACE inhibitors and ARBs prevent migraines?

Q: How effectively do ACE inhibitors and ARBs prevent migraines? Evidence-based answer: The angiotensin-converting enzyme (ACE) inhibitor lisinopril reduces the number of migraines by about 1.5 per month in patients experiencing 2 to 6 migraines monthly (strength of recommendation [SOR]: B, small cross-over trial); the angiotensin II receptor blocker (ARB) candesartan may produce a similar reduction (SOR: C, conflicting crossover trials). Considered as a group, ACE inhibitors and ARBs have a moderate to large effect on the frequency of migraine headaches (SOR: B, meta-analysis of small clinical trials), although only lisinopril and candesartan show fair to good evidence of efficacy. Providers may consider lisinopril or candesartan for migraine prevention, taking into account their effect on other medical conditions (SOR: C, expert opinion). ; Brendan Morris MD; Jon Neher MD, Valley Family Medicine Residency, University of Washington at Valley Medical Center, Renton ; Sarah Safranek, MLIS, University of Washington, Health Sciences Library, Seattle.