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Three Part Question

In [adult patients with acute migraine] is [aspirin as effective as standard treatments] at [resolving pain]?

Clinical Scenario

A 26 year old male presents to the ED with an acute onset severe unilateral frontal headache and photophobia, similar to previous attacks of migraine but unresponsive to paracetamol, ibuprofen and codeine. You have heard anecdotally that aspirin is effective for migraine and decide to consult the available evidence.

Search Strategy

Medline OVID interface 1966 to date. Cochrane Database of Systematic Reviews. CINAHL 1982 to date. EMBASE 1966 to date.
(exp headache$ OR exp migraine$) AND (exp aspirin)

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Kirthi V, Derry S, Moore RA, McQuay HJ April 2010 UK	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.	Systematic Review	2-hour pain-free	NNT 8.1 vs placebo
			2-hour headache relief	NNT 4.9 vs placebo
			24-hour headache relief	NNT 6.6 vs placebo

Comment(s)

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.

Clinical Bottom Line

A single oral dose of 1000 mg of aspirin is effective in relieving migraine headache pain.

References

1. Kirthi V, Derry S, Moore RA, McQuay HJ Aspirin with or without an antiemetic for acute migraine headaches in adults The Cochrane Database of Systematic Reviews 14 Apr 2010; Issue 9