Aspirin with or without an antiemetic for acute migraine headaches in adults.
Author(s): Kirthi V, Derry S, Moore RA, McQuay HJ.
Affiliation(s): Pain Research and Nuffield Department of Anaesthetics, University of Oxford, West
Wing (Level 6), John Radcliffe Hospital, Oxford, Oxfordshire, UK, OX3 9DU.
Publication date & source: 2010, Cochrane Database Syst Rev. , (4):CD008041
BACKGROUND: Migraine is a common, disabling condition and a burden for the
individual, health services and society. Many sufferers choose not to, or are
unable to, seek professional help and rely on over-the-counter analgesics.
Co-therapy with an antiemetic should help to reduce nausea and vomiting commonly
associated with migraine headaches.
OBJECTIVES: To determine the efficacy and tolerability of aspirin, alone or in
combination with an antiemetic, compared to placebo and other active
interventions in the treatment of acute migraine headaches in adults.
SEARCH STRATEGY: We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford
Pain Relief Database for studies through 10 March 2010.
SELECTION CRITERIA: We included randomised, double-blind, placebo- or
active-controlled studies using aspirin to treat a discrete migraine headache
episode, with at least 10 participants per treatment arm.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial
quality and extracted data. Numbers of participants achieving each outcome were
used to calculate relative risk and numbers needed to treat (NNT) or harm (NNH)
compared to placebo or other active treatment.
MAIN RESULTS: Thirteen studies (4222 participants) compared aspirin 900 mg or
1000 mg, alone or in combination with metoclopramide 10 mg, with placebo or other
active comparators, mainly sumatriptan 50 mg or 100 mg. For all efficacy
outcomes, all active treatments were superior to placebo, with NNTs of 8.1, 4.9
and 6.6 for 2-hour pain-free, 2-hour headache relief, and 24-hour headache relief
with aspirin alone versus placebo, and 8.8, 3.3 and 6.2 with aspirin plus
metoclopramide versus placebo. Sumatriptan 50 mg did not differ from aspirin
alone for 2-hour pain-free and headache relief, while sumatriptan 100 mg was
better than the combination of aspirin plus metoclopramide for 2-hour pain-free,
but not headache relief; there were no data for 24-hour headache
relief.Associated symptoms of nausea, vomiting, photophobia and phonophobia were
reduced with aspirin compared with placebo, with additional metoclopramide
significantly reducing nausea (P < 0.00006) and vomiting (P = 0.002) compared
with aspirin alone.Fewer participants needed rescue medication with aspirin than
with placebo. Adverse events were mostly mild and transient, occurring slightly
more often with aspirin than placebo.
AUTHORS' CONCLUSIONS: Aspirin 1000 mg is an effective treatment for acute
migraine headaches, similar to sumatriptan 50 mg or 100 mg. Addition of
metoclopramide 10 mg improves relief of nausea and vomiting. Adverse events were
mainly mild and transient, and were slightly more common with aspirin than
placebo, but less common than with sumatriptan 100 mg.
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