Migraine Prophylaxis: Comparing the Effect of Propranolol and Lisinopril

Background: Migraine is the most common and highly disabling neurological disorder. It is characterized by headaches, having at least five attacks that last 4–72 h, that are unilateral, pulsating, moderate or severe in intensity and aggravated by or cause avoidance of routine physical activity and are also accompanied by nausea/vomiting, and photophobia. Treatment of headaches can be either abortive or prophylactic. Here meaning of prophylactic treatment is to reduce the frequency or severity of headaches. Very few studies have been done regarding the safety and efficacy of lisinopril in migraine prophylaxis so the study focuses on prophylactic therapy for migraine.

Aim and Objective: The aim of the study was (i) to compare the effect of propranolol and lisinopril in migraine as prophylaxis and (ii) to assess the adverse drug reaction of lisinopril.

Materials and Methods: This was a prospective observational, open-label, and comparative study. Sixty outpatients diagnosed with Migraine in the medicine department, HIMS Hassan, and willing to give consent are included for 3 months. Thirty Patients/group, Group 1 – Lisinopril 5 mg/day od (once daily) and Group 2 – Propranolol 20 mg t.i.d. (three times a day) given regular treatment. All the patients were provided with a migraine diary and advised to record the number of attacks of migraine. Patients were followed up at the end of 1st and 3rd months. The change in the migraine frequency and pain intensity was checked (Visual Analog Scale) and also adverse drug reaction. All collected data were entered into an Excel Sheet and analyzed. Descriptive statistics and the Chi-square test were used.

Results: Migraine episodes and headache severity index were reduced by 84% and 43%, with lisinopril compared with propranolol. Other side effects were dizziness and, a tendency to faint was more with propranolol. Days with migraine were reduced in 11 participants for lisinopril. Eight patients reported an adverse effect like cough during lisinopril therapy.

Conclusion: Lisinopril has better prophylactic therapy in migraine. The smaller sample size and short duration of follow-up were the limitations of the study, highlighting the need for future studies on the efficacy of lisinopril for migraine prophylaxis.