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Statins for the prevention of migraine & headache | HeadPain Relief Centre

The potential use of statins for the prevention of migraine was first proposed in a case report a decade ago. A 58-year-old man was prescribed a statin for high cholesterol . He had a history of recurrent typical aura with migraine (approximately two episodes per month) since he was 20 years old. After he began statin therapy, his migraine attacks disappeared.

An open-label study followed with propranolol ( a beta bloker often used for prevention of migraine) daily in women with more than six migraine attacks per month and a statin in women with high cholesterol and more than six migraine attacks per month. Both drugs had a high efficacy (possibly owing to factors such as high expectation for cure); the response rate for propranolol was 88% with a 50% decrease in attacks and 83% for the statin.

A cross-sectional population study of nearly 6000 people found that statin use was associated with a lower prevalence of severe headache or migraine . When the variable of vitamin D status was analyzed, statin use among participants who had optimal blood vitamin D level ( >57 nmol/L )had a much lower risk for severe headache or migraine , while no association was found with people with lower vitamin D levels.

A double-blind, controlled study randomly assigned 57 adults with episodic migraine to either a daily statin plus vitamin D3 1000 IU twice daily or identical placebo for 24 weeks. In the statin/vitamin D group, eight patients (25%) experienced 50% reduction in the number of migraine days at 12 weeks and nine patients (29%) at 24 weeks; only one patient (3%) in the placebo group experienced a reduction in migraine days.

Statins have other biochemical effects in addition to lowering cholesterol, effects that may play a role in reducing migraine attacks. Statins might reduce migraine attack frequency by improving endothelial function, arterial stiffness, and vascular tone. Other actions, such as reducing inflammatory responses and decreasing platelet aggregation and thrombosis, also could contribute to the beneficial effect on migraine.

My opinion;

Firstly, from my perspective the constant use of any drugs to prevent headache/migraine should only be considered when all other conservative treatments have failed.

Also it is important to remember that Statin drugs are currently not recommended or mentioned in guidelines for migraine/headache prevention.

That having been said however, for patients who do not respond to the more common migraine prevention treatments, a statin might be worth a try based on limited evidence and a good safety profile ( although there is an ongoing debate as to whether statins cause side effects such as muscle aches & pains).

Some evidence also suggests that statins might be more effective with adequate vitamin D levels, so determining adequacy of vitamin D would be a sensible first step. Whether one statin is more effective than another for migraine is unknown. More research is required in larger numbers of patients to establish the place of statins in migraine prevention.

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