Aspirin, 1000 mg, reduced moderate to severe pain in acute migraine headache.

et al. Aspirin is efficacious for the treatment of acute migraine. Q Is a single dose of aspirin, 1000 mg, effective for treatment of acute migraine with moderate to severe pain intensity? METHODS Design: Randomised, placebo controlled trial. Blinding: blinded (patients). Follow up period: several time points up to 24 hours. Patients: 485 patients who were 18–50 years of age (mean age 37 y, 79% women, 77% white); had experienced migraine headache, with or without aura, according to International Headache Society (IHS) criteria; had at least moderate pain; and had >1 but (6 migraines per month during the previous year. Exclusion criteria included vomiting >20% of the time during an attack; initiation of preventive medication in the past 3 months or use of alkaloids to treat migraine; use of anticoagulant, gout, or arthritis medications; and previous non-responsiveness to medication for migraine. Intervention: all patients were trained to identify a qualifying migraine attack (based on IHS criteria). Patients who had a qualifying migraine (with or without aura) of at least moderate intensity pain were instructed to take the study medication: 243 were allocated to aspirin, 1000 mg (Extra Strength Bayer Aspirin Caplets, Bayer Consumer Care Division, Morristown, NJ), and 242 were allocated to matched placebo. Patients were encouraged to wait >2 hours before taking rescue medication. Outcomes: primary outcomes were headache response at 2 hours (change in pain intensity [4 point scale] from moderate or severe at baseline to mild or none) and freedom from pain. Other outcomes included reduction in symptoms of nausea, photophobia, and phonophobia; improvement in functional ability; and adverse events. Outcomes were based on patient self report diaries Patient follow up: 401 patients (83%) who took the study medication and had confirmed migraine were included in the analysis. At 2 hours, more patients who received aspirin had a response and were pain free compared with patients who received placebo (table). Pain intensity difference scores were higher in the aspirin group from 1 hour onward. At 2 hours, more patients in the aspirin group had resolution of photophobia and phonophobia; the groups did not differ for resolution of nausea (table). More patients in the aspirin group had improved functional ability from 1–6 hours (p,0.001). The groups did not differ for overall adverse events (table). CONCLUSION Aspirin, 1000 mg, reduced pain, photophobia, and phonophobia in appropriately selected patients with moderate to severe acute migraine pain. Commentary M igraine headaches …