Aspirin is an alternative to ibuprofen or acetaminophen for the temporary self-treatment of migraine, according to a new review by researchers at the University of Oxford.
In more than half of patients who took it, a single 1000-mg dose of aspirin was proven effective as a temporary treatment for acute pain associated with migraine headaches in adults, according to the results of a cumulative study published in the current online issue of the Cochrane Database of Systematic Reviews.
Combining aspirin with an antiemetic, although not necessary for pain relief, was also helpful in decreasing nausea and vomiting linked to migraine, researchers found.
The study’s lead author, Varo Kirthi, of the University of Oxford’s Pain Research and Nuffield Department of Anaesthetics, looked to existing research to establish a consensus on the effectiveness of aspirin as part of a migraine treatment plan. Kirthi and colleagues combed Cochrane CENTRAL, MEDLINE, EMBASE, and the Oxford Pain Relief Database for randomized, double-blind, and placebo- or active-controlled studies that used aspirin to treat a discrete migraine headache episode.
The 13 selected studies involved a total of 4222 participants; used treatment groups of at least 10 participants; and compared aspirin 900 mg or 1000 mg—alone or in combination with metoclopramide 10 mg—with placebo or other active treatments, primarily sumatriptan 50 mg or 100 mg. Researchers then used the numbers of patients who achieved each outcome to calculate relative risk and numbers needed to treat or harm compared with placebo or other active therapy.
Based on the extracted data, a 1000-mg dose of aspirin reduced moderate or severe pain to no worse than mild pain by 2 hours in 52% of patients, compared with 32% taking placebo. Moderate or severe pain was reduced to no pain by 2 hours in 24% of patients, compared with 11% taking placebo.
Among those who did experience pain relief within 2 hours, patients who took aspirin were more likely to sustain that relief over a 24-hour period. Aspirin was also proven more effective than placebo in reducing nausea, vomiting, and sensitivity to light and sound. Adding 10 mg of antiemetic metoclopramide extended these benefits, substantially reducing nausea and vomiting compared with aspirin alone.
With or without metoclopramide, aspirin worked just as well as sumatriptan 50 mg to eliminate pain and provide headache relief. With short-term use, the side effects for aspirin were mostly “mild and transient,” the authors wrote.
R. Andrew Moore, DSc, a researcher involved in the study, told Reuters Health in an e-mail that the information is “useful to know,” but that “no medicine for migraine works in everyone, and for the individual the key is finding that medicine—and formulation—that works for them.”
Moore also urged patients with frequent headaches to seek treatment from a primary care physician. Many patients, however, choose not to see a physician for migraines, opting instead for self-treatment. By including aspirin plus metoclopramide as one option in a range of OTC analgesics typically recommended for migraine relief, pharmacists can increase chances these patients will find an affordable, effective treatment that meets their individual needs.