Single Dose of Aspirin Effective in Relieving Migraine Pain
April 19, 2010 — A single 1000-mg dose of aspirin is an effective treatment of acute migraine headaches for more than half of people who take it, and the addition of 10 mg of metoclopramide may reduce nausea, according to the findings of a literature review published online April 14 in the Cochrane Database of Systematic Reviews.
"Aspirin plus metoclopramide would seem to be a good first-line therapy for acute migraine attacks in this population," write Varo Kirthi, MD, and colleagues, with the Pain Research and the Nuffield Department of Anaesthetics at the John Radcliffe Hospital, in Oxford, United Kingdom.
The researchers searched Cochrane CENTRAL, MEDLINE, EMBASE, and the Oxford Pain Relief Database for studies through March 10, 2010. The 13 selected studies, including 4222 participants, were randomized, double-blind, placebo-controlled, or active-controlled; evaluated the use of aspirin to treat a single migraine headache episode; and included at least 10 participants per treatment group. In addition, studies compared aspirin 900 mg or 1000 mg (alone or in combination) and metoclopramide 10 mg vs placebo or other active comparators (typically sumatriptan 50 mg or 100 mg).
Compared with placebo, aspirin reduced associated symptoms of nausea, vomiting, photophobia, and phonophobia. A single 1000-mg dose of aspirin reduced pain from moderate or severe to no pain by 2 hours in 24% of people vs 11% taking placebo. Severe or moderate pain was reduced to no worse than mild pain by 2 hours in 52% taking aspirin vs 32% taking placebo. Headache relief at 2 hours was sustained for 24 hours more often with aspirin vs placebo.
In addition, metoclopramide, when combined with aspirin, significantly reduced nausea (P < .00006) and vomiting (P = .002) vs aspirin alone, although it had minimal effect on pain. Fewer participants taking aspirin needed rescue medication vs those taking placebo. Adverse events were reported more often with aspirin vs placebo but were mostly mild and transient.
The review also found that aspirin alone was comparable to the prescription medication sumatriptan 50 mg for 2-hour pain-free relief and headache relief, whereas sumatriptan 100 mg was superior to aspirin plus metoclopramide for 2-hour pain-free, but not headache, relief; no data comparing sumatriptan with aspirin for 24-hour headache relief were available.
"Aspirin plus metoclopramide will be a reasonable therapy for acute migraine attacks, but for many it will be insufficiently effective," noted study author R. Andrew Moore, DSc, in a written release. "We are presently working on reviews of other OTC [over-the-counter] medicines for migraines, to provide consumers with the best available evidence on treatments that don’t need a prescription," he said.
Cochrane Database Syst Rev. Posted online April 14, 2010.