“Migraine sufferers could find relief in three aspirin tablets,” reported The Times . It said that researchers have suggested that one in four migraine sufferers could be pain-free within two hours if they take up to 1,000mg of aspirin in one go.
This well-conducted Cochrane review combined the results of 13 trials, which compared aspirin to placebo or another migraine drug. It found that 24% of people given aspirin were pain-free at two hours compared to 11% of those given placebo. Nausea and vomiting associated with migraines were improved with the addition of an anti-sickness drug.
The studies in this review used 900–1,000mg of aspirin. This is a high dose and aspirin is not without adverse effects, nor is it a suitable treatment for everyone. Regular use can increase the risk of stomach irritation and ulceration.
Also, the review found no evidence that aspirin was any more effective than sumatriptan, the most common migraine treatment, or other migraine treatments. Individuals should refer any questions about their treatment to their GP.
The research was carried out by Varo Kirthi and colleagues from the Pain Research and Nuffield Department of Anaesthetics. The work was funded by Pain Research Funds, the NHS Cochrane Collaboration Programme Grant Scheme and the NIHR Biomedical Research Centre Programme. The research was published in the Cochrane Library, an online database of systematic reviews by the Cochrane Collaboration.
The review found no evidence that aspirin is more effective than other migraine treatments, and the Mail’s headline, “Why aspirin could be the best remedy for a migraine”, is incorrect.
This systematic review searched multiple medical databases to find all randomised controlled trials to date on aspirin for treating migraine episodes. Systematic reviews are the best way to reliably collect evidence to assess the overall effectiveness and safety of a particular treatment. Combining the results of different trials can make the effects of a treatment more apparent, but the different methods of the individual trials need to be considered when deciding whether the trials are similar enough for their results to be pooled.
The researchers reviewed medical databases for relevant studies published up to March 2010. To be eligible for inclusion, studies had to have included at least 10 adults with migraines. Migraines had to have been diagnosed according to specific diagnostic criteria, and included people with and without visual aura (the visual changes that some people experience with migraines). Studies also had to compare aspirin to either placebo or to an active drug treatment. Aspirin could have been used either alone or with an antiemetic (anti-sickness medicine).
The researchers assessed the quality of each study. The main outcomes of interest of the review were based on the outcomes considered in the available studies, those that the researchers thought were important outcomes for migraine sufferers, and those suggested by International Headache Society guidance. Based on these considerations, the researchers looked at:
Pain intensity and pain relief were subjective measures rated by the migraine sufferers themselves on a visual scale. Study results were combined using standard statistical methods. The researchers also looked at the rate of adverse effects experienced with aspirin, placebo or the other active treatment tested.
The review included 13 studies with a total 4,222 participants and 5,261 treated migraine attacks. All participants had a history of migraines over the past 12 months, with between one and six attacks of moderate to severe intensity each month. The studies varied in whether they included people taking migraine preventative medicines (prophylaxis) and whether they included people whose migraines were associated with vomiting.
Five studies compared aspirin with placebo, four compared aspirin with active treatment and four compared aspirin with both placebo and active treatment. The amount of aspirin used varied between studies:
Active comparators included sumatriptan, zolmitriptan, paracetamol plus codeine, ibuprofen, and ergotamine plus caffeine. The researchers considered the 900mg and 1,000mg doses of aspirin to be similar enough for the results of these studies to be combined.
The main results for being pain-free at two hours were:
Summary of other outcomes:
The reviewers concluded that 1,000mg of aspirin is an effective treatment for acute migraine headaches with effects similar to sumatriptan. Addition of the antiemetic (10mg of metoclopramide) gave better relief from nausea and vomiting.
This well-conducted review has identified and combined the results of 13 trials that compared the use of aspirin with inactive placebo or another medicine to treat a migraine attack in diagnosed sufferers. It combined studies of different populations of migraine sufferers and several different treatments. Some important points to note are:
Migraines can be extremely debilitating, particularly when associated with their typical symptoms of nausea, vomiting and intolerance to light and sound. Different people have different symptoms and severity of migraines, and some may find relief from aspirin while others may not.
Anyone who has an extremely severe headache and is not known to have migraines or is experiencing a migraine that is more severe than usual should immediately seek medical attention.
Revised: April 23, 2010