Neuroendocrine Derangement in Chronic Migraine

To the editor: We read with great interest the article by Charles et al concerning prophylactic treatment of migraine with olmesartan, wherein 22 of their 24 patients experienced a significant improvement in the frequency and the severity of migraine attacks.1 The reduction in the frequency of migraine attacks was 82.5% and the average reduction rate of headache intensity was 45%. No serious adverse events were recorded and the mean decline of systolic and diastolic blood pressures were 21 and 15 mmHg, respectively. We have some limited experience with olmesartan administered to migraineurs with both hypertension and normal blood pressure. After treatment with olmesartan (20 mg daily), both hypertensive and normotensive migraineurs exhibited a decrease in migraine days and intake of analgesic drugs, severity of headache, and functional disability also were ameliorated in both patient groups. Blood pressures declined to normal in all hypertensive migraineurs and normotensive migraineurs exhibited no significant changes in blood pressure. There were no adverse effects of olmesartan in our patients. Thus, our own preliminary observations concur with those of Charles et al in suggesting that olmesartan can be effective in reducing migraine frequency and severity and is tolerated well in both normotensive and hypertensive patients. We agree with the conclusion by Charles et al1 that large randomized clinical trials are needed to evaluate the safety and utility of olmesartan in migraineurs.