100 Migraine Drugs, A to Z: lisinopril

Lisinopril (Prinivil, Zestril) is a blood pressure medicine in the family of angiotensin-converting enzyme inhibitors (ACEI). At 20 mg a day it was effective in the prevention of migraine headaches, according to a double-blind cross-over study of 60 patients. Three patients stopped the drug due to cough.

An open-label study of 5 mg of lisinopril in 21 patients was also positive but 3 patients stopped it because of cough. ACEIs but not angiotensin receptor blockers (ARBs) which are similar to ACEIs can cause cough. The occurrence of cough is not dose-dependent.

A review of a large database of prescriptions showed that patients taking ACEIs or ARBs were getting 50% fewer prescriptions for abortive migraine drugs compared to those taking a diuretic, which is another type of drug to treat hypertension.

The advantage of ACE inhibitors and ARBs over beta-blockers such as propranolol is that they do not lower the heart rate, which can make exercise difficult. Both can cause fatigue and dizziness due to the lowering of blood pressure, but the weight gain and depression, occasionally seen with propranolol does not happen with ACEIs and ARBs. On the other hand, beta-blockers can sometimes help reduce anxiety and palpitations.