Take Two of These… And You Still Might Have Pain

Migraines are severe, often debilitating, headaches that may be accompanied by visual symptoms, as well as nausea and vomiting. Migraines may last up to 24 hours. The exact cause of migraine is unknown, and most treatment focuses on acute pain relief once the migraine begins. For many migraine sufferers, acute pain relief is often ineffective at relieving the migraine symptoms. But, a new analysis published in the Cochrane Database of Systemic Reviews reveals that a single dose of aspirin is effective for more than half of migraine sufferers.

The exact cause of migraines is unknown, and frequent, severe migraines significantly decrease quality of life for the patient and, often, his or her family. As many as 12% of people in Western countries experience migraine headaches, and women are 3 times as likely as men to be migraine sufferers. Migraines most commonly occur between the ages of 30 and 50. Additional risk factors for migraines include medication overuse, temporomandibular disorders, obstructive sleep apnea and obesity. Nearly all migraine sufferers treat the pain associated with migraine with medications for acute pain relief. Most often, these include over-the-counter remedies such as aspirin, ibuprofen, acetaminophen, and caffeine. Many patients still do not find relief, and several prescription options for migraine pain relief have been developed in recent years.

The new analysis of 13 studies included more than 4000 patients; it analyzed the effectiveness of aspirin for acute pain relief related to migraine. Overall, a single dose of 900 or 1000 mg of aspirin was more effective at reducing pain, nausea and vomiting, and sensitivity to light and sound compared to placebo. Aspirin exhibited similar efficacy compared to common prescription migraine remedies, including sumatriptan. A single dose of aspirin reduced moderate to severe pain to no pain in 2 hours in 24% of patients, compared to 11% of patients receiving placebo; aspirin reduced moderate to severe pain to no worse than mild pain in 52% of patients, compared to 32% of patients receiving placebo.

Migraine treatments can be very expensive, and many patients attempt to treat migraines with over-the-counter remedies whenever possible. However, according to the new study, aspirin still leaves nearly half of migraine sufferers with pain. Plus, aspirin is well-known to cause side effects, including gastrointestinal toxicity and bleeding disorders, and interacts with many prescription and over-the-counter medications.

So what is a migraine sufferer to do? While the exact cause of migraine headaches is unclear, many patients can identify individual triggers, such as food, drinks, activities or hormonal fluctuations, that provoke migraine attacks. Avoiding the triggers is the best way to prevent the disability and pain associated with migraines. When this is not possible, patients need accessible, effective, inexpensive relief from pain. New preventive treatments, including anticonvulsant drugs, onabotulinum toxin, muscle relaxants, nerve blocks, and neural stimulation, are being investigated, but are yet unavailable for widespread migraine relief.

Migraine headaches warrant additional research to determine the cause and treatment options to effectively eliminate this debilitating condition. Health care providers should be aware of the risk factors for migraine and aid patients in identifying migraine triggers.

References

Goldstein J, Silberstein SD, Saper JR, Ryan RE Jr, & Lipton RB (2006). Acetaminophen, aspirin, and caffeine in combination versus ibuprofen for acute migraine: results from a multicenter, double-blind, randomized, parallel-group, single-dose, placebo-controlled study. Headache, 46 (3), 444-53 PMID: 16618262

Kirthi V, Derry S, Moore RA, & McQuay HJ (2010). Aspirin with or without an antiemetic for acute migraine headaches in adults. Cochrane database of systematic reviews (Online), 4 PMID: 20393963

Lampl C, Voelker M, & Diener HC (2007). Efficacy and safety of 1,000 mg effervescent aspirin: individual patient data meta-analysis of three trials in migraine headache and migraine accompanying symptoms. Journal of neurology, 254 (6), 705-12 PMID: 17406776

Lovell BV, & Marmura MJ (2010). New therapeutic developments in chronic migraine. Current opinion in neurology, 23 (3), 254-8 PMID: 20442572

Paemeleire K, & Bartsch T (2010). Occipital nerve stimulation for headache disorders. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 7 (2), 213-9 PMID: 20430321

Steiner TJ, & Voelker M (2009). Gastrointestinal tolerability of aspirin and the choice of over-the-counter analgesia for short-lasting acute pain. Journal of clinical pharmacy and therapeutics, 34 (2), 177-86 PMID: 19250138