Beta-adrenoceptor blockers and calcium antagonists in the prophylaxis and treatment of migraine

Abstract

Based on published reports of controlled double-blind studies, the efficacy of beta-receptor blockers and calcium antagonists in the prophylactic treatment of migraine is reviewed. Taking into consideration problems in trial design and evaluation of the effects of treatment, and the amount of documentation, it may be concluded that propranolol, metoprolol, timolol, nadolol and atenolol have been shown to reduce the frequency of migraine attacks in patients with common as well as classical migraine. The effect on duration and intensity of migraine attacks is less clear. Treatment effect is generally seen within 4 weeks, but seems to increase with time. Nonselective beta-receptor blockers as well as drugs selective for beta1-receptors may be effective, and their efficacy is comparable to that of other active antimigraine drugs. Available studies do not exclude the fact that beta-receptor blockers with partial agonist activity (intrinsic sympathomimetic activity) have an effect, but suggest that their efficacy is inferior to that of blockers lacking this property. Among the calcium antagonists tested for prophylactic effect in migraine, the effects of verapamil, nifedipine and diltiazem seem promising, but available documentation does not allow any definitive statements of efficacy to be made, particularly not for nifedipine and diltiazem. The ability of flunarizine to reduce the frequency of migraine attacks in patients with common and classical migraine is well documented; its effect on attack duration and intensity is less well established. The response rate is similar to that for beta-receptor blockers, and to that, for example, for pizotifen (pizotyline). Nimodipine also appears to reduce the frequency of migraine attacks, but the efficacy of this drug, compared with other alternatives, remains to be definitely established.