Matthew is an associate editor of The American Journal of Managed Care® (AJMC®). He has been working on AJMC® since 2019 after receiving his Bachelor's degree at Rutgers University–New Brunswick in journalism and economics.
Aspirin, in high doses from 900 to 1300 mg, was shown to be an effective and safe treatment option for acute migraine headaches, with further research showing its potential efficacy in preventing recurrent migraine headaches through lower doses of 81 to 325 mg, according to findings of a review.
Aspirin, in high doses from 900 to 1300 mg, was shown to be an effective and safe treatment option for acute migraine headaches, with further research showing its potential efficacy in preventing recurrent migraine headaches through lower doses of 81 to 325 mg, according to a November review published in The American Journal of Medicine.1
As the authors note, treatment for acute migraine as well as prevention of recurrent attacks can be achieved using effective prescription drugs of shown benefit, but for those with high co-pays or without health insurance, these medications may not be available or affordable. Nationwide, rates of uninsured or underinsured individuals are estimated to be 8.5%, with a stark 13% prevalence in Florida.
Researchers from Florida Atlantic University’s Schmidt College of Medicine sought to address issues regarding affordability and access by examining the efficacy of low-cost aspirin as an effective and preventive treatment of acute migraine. Assessments conducted in the review included a meta-analysis of 13 randomized trials for the treatment of migraine in 4222 patients given either 900 to 1000 mg of aspirin, with and without 10 mg of metoclopramide, or 50 to 100 mg of sumatriptan. The review additionally included studies totaling more than 40,000 patients for prevention of recurrent attacks.
High-Dose Aspirin for Treatment at Onset of Acute Migraine
In the meta-analysis, the prespecified primary end point was distinguished as reduction in headache pain or complete remission of pain at 1 hour, 2 hours, and sustained reduction/remission over 24 hours.
Study results revealed that there were no significant differences between the 2 treatments between high-dose aspirin and either 50 mg or 100 mg of sumatriptan. For the primary end point, high-dose aspirin significantly reduced headache at 1 hour by 60% (95% CI, 1.3-2.0) when compared with 50 mg of sumatriptan. While 100 mg of sumatriptan produced a definite 37% reduction (95% CI, 0.45-0.87) when compared with high-dose aspirin and metoclopramide after 2 hours, the effectiveness of high-dose aspirin at initial onset of migraine stresses its efficacy as a low-cost treatment.
Low-Dose Aspirin for Preventive Treatment of Recurrent Migraines
In testing efficacy of low-dose aspirin as a preventive treatment, the researchers referenced multiple studies examining its impact on recurrent migraines. In a trial among British doctors cited in the review, 5139 men were randomized to 500 mg daily aspirin in an open design, with a significant 29% reduction in recurrent migraines exhibited at the end of the trial.
Additionally, the United States Physicians’ Health Study randomized 22,071 male physicians to either 325 mg aspirin on alternate days or matching placebo, and after 60.2 months of treatment and follow-up, the trial was terminated early based on the unanimous recommendation of the Data and Safety Monitoring Board. The recommendation was attributed to the statistically significant 44% reduction in first myocardial infarction among those assigned randomly to aspirin, and among this group, a 22% reduction in subsequent attacks of migraine at baseline was shown.
In an editorial on the review,2 Joseph Alpert, MD, editor-in-chief of The American Journal of Medicine, highlighted that “since aspirin is readily available without a prescription in the US, it certainly seems like something that should be tried in migraine sufferers before physicians prescribe more complex, expensive, and hence less available medications.” As only 20% of people with migraine are shown to see a physician for their condition, and less than 10% receive effective therapy, the potential of aspirin as an over-the-counter, low-cost therapy could reduce migraine incidence and severity.
“If aspirin works to abort or ameliorate the headaches, then it should be tried as a prophylactic measure to see if it can prevent the occurrence of these debilitating headaches. Hopefully, this would lead to less disability and loss of employment time for these patients who are so common in the US and throughout the world,” said Alpert.
1. Biglione B, Gitin A, Gorelick PB, et al. Aspirin in the treatment and prevention of migraine headaches: possible additional clinical options for primary healthcare providers [published online November 8, 2019]. Am J Med. doi: 10.1016/j.amjmed.2019.10.023.
2. Alpert JS. A common drug may help patients with debilitating migraine headaches [published online December 2, 2019]. Am J Med. doi: 10.1016/j.amjmed.2019.11.002.