Exploring Aspirin for the Treatment and Prevention of Migraines

Migraine is a common neurological condition and one of the largest causes of disabilities worldwide. Despite this, the condition is both underdiagnosed and undertreated. Over 90% of people who suffer from migraine report moderate to severe pain, with 1% to 5% of individuals experiencing recurring migraines. Over 50% of this population report severe impairment, reduced work or school productivity, and/or the need for bed rest.¹ Additionally, research indicates a higher prevalence of migraine reported in women compared to men.²

Several medications are prescribed for the treatment of migraines, each with varying levels of efficacy. Some of the most common medications include angiotensin-converting enzyme inhibitors, antiseizure drugs, beta-blockers, calcium blockers, antidepressants, and nonsteroidal anti-inflammatory drugs (NSAIDs). Despite their effectiveness, many of these drugs may not be readily available, are poorly tolerated, or are contraindicated. Indeed, there is growing evidence supporting the fact that many US patients are inadequately treated for migraines due to the high cost of medications, as well as limited access to health care.¹

In one systematic review, study researchers found migraines to be particularly common and burdensome for historically disadvantaged segments of the population.³ This is a noteworthy observation since treatments for migraines are rapidly improving and becoming more targeted and personalized – and therefore more expensive and inaccessible for these segments.

Could aspirin offer a solution? Current evidence has demonstrated the effectiveness of aspirin as an over-the-counter treatment for acute migraines with the added appeal of safety, low cost, and a relatively favorable side effect profile. Additionally, aspirin has not only been effective as a treatment for current migraine; it has also demonstrated prophylactic (preventative) properties.

High-dose aspirin for the treatment of acute migraine

Research indicated that aspirin was effective for acute migraines both as a solitary modality and in combination with other drugs.⁴ Aspirin functions to irreversibly inhibit cyclooxygenase enzymes (COX-1 and COX-2), which results in decreased prostaglandin synthesis and a reduction in pain and inflammation.⁵ Studies to date have confirmed the beneficial effects of aspirin on migraine without aura, but its effects on migraine with aura are unclear and require further investigation.⁶

Research on the effectiveness of aspirin in the treatment of migraine alone or in combination with other drugs is ongoing. Metoclopramide is an antiemetic that is often prescribed alongside high-dose aspirin to treat acute migraine. A meta-analysis of 13 randomized control trials (RCTs) comparing 1,000mg of aspirin (with and without 10mg of metoclopramide) to placebo or sumatriptan (Imitrex; 50mg or 100mg), found no significant differences between aspirin and 50mg or 100mg of sumatriptan doses when assessing reduced head pain or complete remission of pain.⁷

A study assessing the effects of aspirin alone found that, when administered between the ranges of 900 mg to 1000mg, aspirin was effective in providing relief at 2 hours for between 48% and 52% of participants, compared with between 19% and 34% in the placebo group.⁸ An RCT of 433 patients demonstrated that 1000mg of aspirin produced similar benefits when compared to 50mg of sumatriptan.⁹ This was further supported by recent research concluding that high-dose aspirin administered between the ranges of 900mg to 1300mg was effective in patients with migraines when compared with alternative, more expensive therapies such as beta-blockers or antiseizure drugs.¹

Many of these studies also reported a decrease in the frequently concomitant symptoms of nausea, photophobia, and phonophobia in patients receiving 900mg to 1300mg of aspirin.¹ Furthermore, randomized evidence on the side effects of aspirin showed promising results in comparison to both traditional, nonselective NSAIDs, and cyclooxygenase-2 inhibitors.¹⁰

This article originally appeared on Neurology Advisor