using monoamine oxidase inhibitors (MAOIs). Antidepressants
may be especially useful for migraine prophylaxis in patients with
concurrent anxiety, depression, insomnia, and chronic pain.10,11
Angiotensin blockade agents. Recent studies have shown that
angiotensin blockade agents are useful in the prevention of migraine.
Although the exact mechanism is unknown, inhibition of angiotensin
II has several effects that may be relevant to migraine such as
modulation of cerebrovascular flow and effects on autonomic pathways,
neuroendocrine systems, and fluid and electrolyte homeostasis.13
The angiotensin-converting enzyme inhibitor (ACEI) lisinopril
has demonstrated some effectiveness in the prevention of migraine.10
Approximately 30% of patients experienced migraine half as often
when compared to no therapy. It is generally well tolerated; the most
common adverse effect is cough. The angiotensin receptor blocker
(ARB) candesartan showed similar results; approximately 40% of
patients had their migraine frequency reduced by half or more.
Adverse effects associated with candesartan were similar to placebo.
Although the evidence for the use of these agents in migraine
prophylaxis is limited, they have a good side effect profile. Thus,