James Hughes, MD
What are the efficacy and safety of aspirin for acute migraine headaches in adults?
Included studies compared aspirin with placebo or active control in patients ≥ 18 years of age who had discrete migraine headache episodes as defined by the International Headache Society. Antiemetics could be used either in a single formulation with aspirin or ≤ 30 minutes before aspirin. All medications had to be self-administered. Outcomes included freedom from pain at 2 hours, sustained pain reduction over 24 hours (headache relief at 2 h, sustained for 24 h, with no use of rescue medication or a second dose of study medication), and adverse events within 24 hours.
MEDLINE and EMBASE/Excerpta Medica (to Mar 2010), Oxford Pain Relief Database, Cochrane Central Register of Controlled Trials (Issue 1, 2010), and reference lists were searched for double-blind, randomized controlled trials with ≥ 10 patients per treatment group that reported dichotomous data for ≥ 1 of the study outcomes. Crossover studies were required to have adequate washout between treatments. 13 trials (n = 4222, mean age 37 to 44 y) met the selection criteria. Aspirin doses were 900 or 1000 mg. All trials had Oxford Quality Scores ≥ 3 out of 5.
The main results are in the Table.
In adults with acute migraine headaches, aspirin, with or without metoclopramide, is more effective than placebo at eliminating headache pain at 2 hours and reducing pain over 24 hours. Sumatriptan, 100 mg, is more effective than aspirin for eliminating headache pain at 2 hours. Aspirin increases adverse events compared with placebo.
Aspirin (Asp) vs control in adults with acute migraine headaches*
*Met = metoclopramide; other abbreviations defined in Glossary. RBI, RBR, RRI, NNT, NNH, and CI calculated from control event rates, risk ratios, and risk differences in article.
Hughes J. Review: Aspirin reduces acute migraine pain in adults. Ann Intern Med. ;153:JC5–5. doi: 10.7326/0003-4819-153-10-201011160-02005
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Published: Ann Intern Med. 2010;153(10):JC5-5.
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