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.