The effects of angiotensin receptor blockers as prophylactic migraine treatment: A systematic review and meta-analysis

Background The role of angiotensin II receptor blockers (ARBs) in migraine prophylaxis varies globally, partly due to insufficient evidence from randomized controlled trials (RCTs) supporting their efficacy. We aimed to conduct a systematic review and meta-analysis of ARBs in migraine prophylaxis. Methods We searched PubMed/MEDLINE, Embase, Cochrane, Google Scholar, Clinicaltrials.gov, ITCRP, and EudraCT from database inception to 22 September 2025. The searches were conducted between 19 and 22 September 2025 for controlled trials comparing any ARB to placebo or other preventive migraine drugs in individuals with episodic or chronic migraine. Guidelines, letters, editorials, narrative reviews, case reports, and news were excluded. Summary data were extracted by two reviewers, and random-effects meta-analyses were performed, with heterogeneity assessed using Cochrane I 2 statistic. Primary outcomes were monthly headache/migraine days or attacks, and response rates. Adverse event occurrence was also assessed. The risk of bias was assessed using the Cochrane RoB2 tool and the certainty of evidence was assessed using GRADEpro. The study was pre-registered in Prospero (CRD42023405372) and received no funding. Results Four trials published between 2003 and 2025 were included in the meta-analysis: three RCTs on candesartan, and one on telmisartan. All four studies reported the outcomes migraine days and responder (≥50% reduction of migraine days) rates, and three reported headache days. A total of 659 participants were included in the meta-analysis. The combined effect size for migraine days and headache days were reductions of −1.00 (95% CI: −1.51 to −0.49, p