The appropriate dose of candesartan for the prophylaxis of migraine is generally 8 mg once daily, which may be increased to 16 mg once daily depending on clinical response and tolerability. This dosing regimen is supported by recent clinical trial evidence demonstrating candesartan's efficacy in migraine prevention.
Although the UK NICE headache guideline CG150 does not specifically recommend candesartan as a first- or second-line prophylactic treatment for migraine, likely due to limited routine use or licensing in this indication, emerging evidence from a randomized, triple-blind, placebo-controlled phase 2 trial supports the use of candesartan at these doses for episodic migraine prevention.
In this recent trial by Øie et al. (2025), candesartan at 8 mg once daily with possible titration to 16 mg once daily showed superior efficacy compared to placebo in reducing migraine frequency, with good tolerability.
Given the lack of explicit dosing guidance in UK guidelines and the supporting clinical trial data, candesartan dosing for migraine prophylaxis should start at 8 mg once daily, increasing cautiously to 16 mg daily as needed and as tolerated.
Clinicians should consider patient-specific factors and monitor for potential side effects typical of angiotensin receptor blockers. As candesartan is primarily licensed as an antihypertensive, its use for migraine prophylaxis is an off-label indication and requires appropriate clinical judgement and patient discussion.
Key References
- CG150 - Headaches in over 12s: diagnosis and management
- CKS - Headache - medication overuse
- CKS - Headache - tension-type
- NG133 - Hypertension in pregnancy: diagnosis and management
- CKS - Migraine
- (Gales et al., 2010): Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for the prevention of migraines.
- (Linde et al., 2013): Valproate (valproic acid or sodium valproate or a combination of the two) for the prophylaxis of episodic migraine in adults.
- (Øie et al., 2025): Candesartan versus placebo for migraine prevention in patients with episodic migraine: a randomised, triple-blind, placebo-controlled, phase 2 trial.