Candesartan for Migraine Prophylaxis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

This study aimed to synthesize evidence from randomized controlled trials (RCTs) on the efficacy of candesartan for migraine prophylaxis.

Migraine is a highly prevalent and disabling neurological disorder for which many patients remain inadequately controlled or intolerant to existing preventive therapies. Although several effective options exist, their use is often limited by adverse effects, contraindications, cost, or restricted access. There is a clear need for effective, safe, affordable, and widely available oral preventive treatments.

We comprehensively searched PubMed, Scopus, Web of Science, and Cochrane Library databases to identify all RCTs assessing candesartan versus placebo for migraine prophylaxis. Eligible RCTs were included, and their data were extracted and analyzed using RevMan Web.

Three RCTs comprising 589 participants met the inclusion criteria. Compared with placebo, candesartan significantly reduced monthly migraine days (MMDs) (MD: -1.13; 95% CI: -1.51 to -0.76; P < 0.00001), monthly headache days (MHDs) (MD: -1.25; 95% CI: -1.73 to -0.77; P < 0.00001), and monthly triptan doses (MD: -1.00; 95% CI: -1.36 to -0.65; P < 0.00001). However, the reduction in monthly analgesic doses was not statistically significant (MD: -1.10; 95% CI: -3.13 to 0.94; P = 0.29).

Candesartan is effective as a preventive treatment for migraine. However, further studies must be conducted globally in larger, more diverse, and longer-term patient populations.