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CME/CE

Single Dose of Aspirin Effective in Relieving Migraine Pain

  • Authors: News Author: Emma Hitt, PhD
    CME Author: Charles P. Vega, MD
  • CME/CE Released: 4/19/2010
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 4/19/2011
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Target Audience and Goal Statement

This article is intended for primary care clinicians, neurologists, pain medicine specialists, and other specialists who care for patients with migraine headache.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  1. Describe epidemiologic clues in the diagnosis of migraine headache.
  2. Describe effective treatments of acute migraine headaches.


Disclosures

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Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Author(s)

  • Emma Hitt, PhD

    Emma Hitt is a freelance editor and writer for Medscape.

    Disclosures

    Disclosure: Emma Hitt, PhD, has disclosed no relevant financial relationships.
    Dr. Hitt does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.
    Dr. Hitt does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor(s)

  • Brande Nicole Martin

    CME Clinical Editor, Medscape, LLC

    Disclosures

    Disclosure: Brande Nicole Martin has disclosed no relevant financial relationships.

CME Author(s)

  • Charles P. Vega, MD

    Associate Clinical Professor, Residency Program Director, Prime-LC, University of California-Irvine, Orange, California; Department of Family Medicine, University of California-Irvine, Orange, California

    Disclosures

    Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

CME Reviewer/Nurse Planner

  • Laurie E. Scudder, MS, NP

    Accreditation Coordinator, Continuing Professional Education Department, Medscape, LLC; Clinical Assistant Professor, School of Nursing and Allied Health, George Washington University, Washington, DC; Nurse Practitioner, School-Based Health Centers, Baltimore City Public Schools, Baltimore, Maryland

    Disclosures

    Disclosure: Laurie E. Scudder, MS, NP, has disclosed no relevant financial relationships.


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CME/CE

Single Dose of Aspirin Effective in Relieving Migraine Pain

Authors: News Author: Emma Hitt, PhD CME Author: Charles P. Vega, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME/CE Released: 4/19/2010

Valid for credit through: 4/19/2011

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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. Abstract

Additional Resource

More information about drugs for managing migraine headaches is posted online in the newsletter Treatment Guidelines From The Medical Letter.

Clinical Context

Migraine headache occurs in approximately 12% of individuals living in Western countries, according to the authors of the current review. Women may be 3 times more likely to have migraine vs men, and it is most common between the ages of 30 and 50 years. Migraine without aura is more common than migraine with aura.

Nearly all patients with migraine headaches use medications to treat acute pain. Although there are many options for abortive therapy for migraine, simple over-the-counter analgesics could have a role in treatment. The current systematic review examines the usefulness of aspirin in the treatment of acute migraine headache.

Study Highlights

  • Researchers focused on randomized, double-blind studies of aspirin for the acute treatment of migraine headache in adults provided that the study had at least 10 participants. Aspirin could be compared vs placebo or vs another analgesic, and researchers included studies of a combination of aspirin plus an antiemetic.
  • The main study outcomes were pain relief at 2 hours after treatment and pain levels in the 24 hours after treatment. Researchers also followed headache-related symptoms, such as nausea, and adverse events related to treatment.
  • 13 studies, with a total of 4222 patients, met inclusion criteria for the review. The mean ages of participants in the included research were 37 to 44 years. All participants had a history of migraine for at least 12 months, and the headaches were of moderate to severe intensity.
  • 5 studies had a placebo comparator to aspirin, 4 studies had an active comparator, and 4 studies included both placebo and an active comparator.
  • The dose of aspirin was 900 to 1000 mg. The most common active comparator drug was sumatriptan.
  • The proportions of participants reporting no pain at 2 hours was 24% with aspirin and 11% with placebo, a significant difference. Aspirin was also associated with better rates of headache relief at 1 hour vs placebo.
  • In active comparator studies, the proportions of participants reporting no pain at 2 hours was 26% with aspirin and 32% with sumatriptan 50 mg, and the difference between treatments in this outcome was not significant.
  • The proportions of participants reporting sustained headache relief at 24 hours were 39% with aspirin 1000 mg and 24% with placebo, a significant difference. Aspirin and sumatriptan 50 mg were associated with similar levels of 24-hour headache relief.
  • Aspirin was superior to placebo in reducing phonophobia, photophobia, and nausea associated with migraine headache.
  • Adding metoclopramide to aspirin did not improve pain outcomes vs aspirin alone. However, adding metoclopramide did reduce the rates of nausea and vomiting.
  • Aspirin use significantly reduced the need for rescue medications vs placebo, and it reduced functional disability during headache in 1 study.
  • There was a slight increase in the rate of reported adverse events with aspirin vs placebo, but serious adverse events related to study treatments were rare. Sumatriptan 100 mg was associated with higher rates of adverse events vs aspirin.

Clinical Implications

  • Migraine headache is more common among women and among individuals between the ages of 30 to 50 years. Migraine without aura is more common than migraine with aura, and nearly all patients with migraine headache use analgesics during acute attacks.
  • The current review finds that aspirin is more effective than placebo at reducing acute pain in migraine headaches, eliminating headache for 24 hours, and reducing the need for rescue medications. Aspirin was similarly effective to sumatriptan overall, and adding metoclopramide to aspirin reduced nausea and vomiting, but not the degree of analgesia itself.

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