Randomised trial on episodic cluster headache with an angiotensin II receptor blocker

• Published in: Cephalalgia Vol. 33; no. 12; pp. 1026 - 1034
• Main Authors: Tronvik, Erling, Wienecke, Troels, Monstad, Inge, Dahløf, Carl, Bøe, Magne Geir, Tjensvoll, Anne Bolette, Salvesen, Rolf, Zwart, John Anker, Jansson, Sven-Olof, Stovner, Lars Jacob
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.09.2013
• Subjects: Adult; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Benzimidazoles - therapeutic use; Cluster Headache - drug therapy; Double-Blind Method; Female; Humans; Male; Scandinavian and Nordic Countries; Tetrazoles - therapeutic use; Treatment Outcome; Scandinavian and Nordic Countries; angiotensin; headache; Randomised controlled trial; cluster headache; candesartan
• ISSN: 0333-1024; 1468-2982
• DOI: 10.1177/0333102413484989

Objectives The aim of this study was to evaluate the angiotensin II receptor antagonist candesartan as prophylactic medication in patients with episodic cluster headache. Methods This study comprised a prospective, placebo-controlled, double-blind, parallel-designed trial performed in seven centres in Scandinavia. Forty (40) patients with episodic cluster headache (ICHD-2) were recruited and randomised over a five-year period to placebo or 16 mg candesartan in the first week, and placebo or 32 mg candesartan in the second and third week. Results The number of cluster headache attacks (primary efficacy variable) during the three-week treatment period was reduced from 14.3 ± 9.2 attacks in week 1 to 5.6 ± 7.0 attacks in week 3 (−61%) in the candesartan group and from 16.8 ± 14.1 attacks in week 1 to 10.5 ± 11.3 attacks in week 3 (−38%) in the placebo group. The difference between the candesartan and placebo group was not significant with the pre-planned non-parametric ranking test, but a post-hoc exact Poisson test, which takes into account the temporal properties of the data, revealed a significant result (p < 0.0001). Conclusions This was a negative trial. Post-hoc statistics suitable to describe the temporal changes in cluster headache indicate that conduction of future larger studies may be justified.