Researcher Harald Schrader, MD, says serendipity played a large role in his decision to study a popular blood pressure drug as a preventive therapy for migraines. The Norwegian University of Science and Technology professor says he had suffered from crippling headaches for several years when he also was found to have high blood pressure.

"I was placed on [the blood pressure medication] lisinopril, and my headaches got better almost immediately," Schrader tells WebMD. "Soon after that, we gave the drug to a woman we were treating for disabling migraines who also had borderline high blood pressure. A few weeks later, we got a hand-written, four-page letter from her telling us that the treatment had given her a new life."

Schrader and colleagues now have more scientific evidence that lisinopril, which goes under various trade names such as Prinivil or Zestril and is among the class of high blood pressure medicines known as ACE inhibitors, really does prevent migraines. In the Jan. 6 issue of the British Medical Journal, they report that the therapy appears to work as well as other preventive agents with fewer side effects.

For a frequent migraine sufferer, reducing the number of agonizing headaches that occur each month could mean the difference between living a relatively normal life and living in constant pain or fear of pain. Several drugs or drug classes, including beta-blockers, which are used for heart problems and high blood pressure, and certain antiseizure drugs, have been shown to reduce migraine frequency in many patients, but side effects such as weight gain and sluggishness make them less than ideal for long-term use.

"At present, the preventive treatments for migraines are still rather unsatisfactory," former International Headache Society president Ninan T. Mathew, MD, tells WebMD. "We are still on the lookout for something that can be taken long term with reasonable results. From this point of view, this ACE inhibitor seems to be a reasonable choice." Mathew, who is director of the Houston Headache Clinic in Houston, Texas, reviewed the study for WebMD.

In this study, funded by one lisinopril manufacturer, AstraZeneca, Schrader and colleagues treated almost 50 patients with either lisinopril or a placebo for a 12-week period. They then switched the medications so that those formerly on the placebo received the active drug for a 12-week period and those formerly given lisinopril received the placebo. Participants were asked to record their total hours with headache, days with headache, and days with migraine in a diary. They also recorded which medicine they used to treat headaches and days they missed from work due to headaches.

In nearly a third of the patients, symptoms were reduced by half while on lisinopril. These patients also had fewer overall days with migraine.

Schrader says, that although it is difficult to compare this study with other studies, because it is so different, "[It] appears to us that the effectiveness of this agent is in the same range as beta-blockers and [the anti-seizure drug] sodium valproate."

Mathew says larger studies are needed to determine whether ACE inhibitors like lisinopril are a better choice for the prevention of migraines than medications that are now commonly prescribed. He says that migraine patients now have more choices than ever for both the prevention and treatment of their headaches.

"The field of migraine treatment has changed completely in the last 15 or 20 years," he says. "The majority of patients with migraines can be managed very well. The main problem today is that many physicians haven't kept up and don't know how to treat migraines. The most common mistake is to treat a migraine like any other pain."

Mathew says the most important thing a patient can do is find a doctor who is knowledgeable about the treatment of migraines.

"Patients are often given pain medications and combinations of medicines that are not appropriate for the treatment of migraines," he says. "If you fracture your arm, you are given morphine or codeine for the pain, but the same approach should not be applied to migraines. There are very good [medications that are best for migraines] out there, and there is no excuse for a doctor not to know about them."

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