Migraine aspirin: Aspirin in the Treatment and Prevention of Migraine Headaches: Possible Additional Clinical Options for Primary Healthcare Providers

17.08.202311.06.2023 by alexxlab

Aspirin in the Treatment and Prevention of Migraine Headaches: Possible Additional Clinical Options for Primary Healthcare Providers

Review

. 2020 Apr;133(4):412-416.

doi: 10.1016/j.amjmed.2019.10.023.

Epub 2019 Nov 9.

Bianca Biglione¹, Alexander Gitin², Philip B Gorelick³, Charles Hennekens⁴

Affiliations

¹ Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton.
² University of Florida College of Medicine, Gainesville.
³ Department of Translational Neuroscience, Michigan State University College of Medicine, Grand Rapids.
⁴ Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Electronic address: [email protected].

PMID:
31712099
DOI:
10.1016/j.amjmed.2019.10.023

Review

Bianca Biglione et al.

Am J Med.

2020 Apr.

. 2020 Apr;133(4):412-416.

doi: 10.1016/j.amjmed.2019.10.023.

Epub 2019 Nov 9.

Authors

Bianca Biglione¹, Alexander Gitin², Philip B Gorelick³, Charles Hennekens⁴

Affiliations

¹ Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton.
² University of Florida College of Medicine, Gainesville.
³ Department of Translational Neuroscience, Michigan State University College of Medicine, Grand Rapids.
⁴ Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Electronic address: [email protected].

PMID:
31712099
DOI:
10.1016/j.amjmed.2019.10.023

Abstract

Migraine headaches are among the most common and potentially debilitating disorders encountered by primary healthcare providers. In the treatment of acute migraine and the prevention of recurrent attacks, there are prescription drugs of proven benefit. However, for those without health insurance or high co-pays, these drugs may be neither available nor affordable and, for all patients, they may be either poorly tolerated or contraindicated. The totality of evidence, which includes data from randomized trials, suggests that high-dose aspirin, in doses from 900 to 1300 mg, taken at the onset of symptoms, is an effective and safe treatment option for acute migraine headaches. In addition, the totality of evidence, including some, but not all, randomized trials, suggests the possibility that daily aspirin, in doses from 81 to 325 mg, may be an effective and safe treatment option for the prevention of recurrent migraine headaches. The relatively favorable side effect profile of aspirin and extremely low costs compared with other prescription drug therapies may provide additional options for primary healthcare providers in the treatment of both acute and recurrent migraine headaches.

Keywords:

Aspirin; Migraine; Prevention; Primary healthcare providers; Treatment.

Cited by

Revisiting Migraine: The Evolving Pathophysiology and the Expanding Management Armamentarium.
Gawde P, Shah H, Patel H, Bharathi KS, Patel N, Sethi Y, Kaka N.
Gawde P, et al.
Cureus. 2023 Feb 2;15(2):e34553. doi: 10.7759/cureus.34553. eCollection 2023 Feb.
Cureus. 2023.
PMID: 36879707
Free PMC article.
Review.
Clinical characteristics and management of headache in patients with myeloproliferative neoplasms.
Shimoyama T, Yamaguchi H, Kimura K, Suzuki F, Hayashi T, Wakita S.
Shimoyama T, et al.
Front Neurol. 2022 Dec 6;13:1051093. doi: 10.3389/fneur.2022.1051093. eCollection 2022.
Front Neurol. 2022.
PMID: 36561301
Free PMC article.
Migraine in Patients Undergoing PFO Closure: Characterization of a Platelet-Associated Pathophysiological Mechanism: The LEARNER Study.
Trabattoni D, Brambilla M, Canzano P, Becchetti A, Teruzzi G, Porro B, Fiorelli S, Muratori M, Tedesco CC, Veglia F, Montorsi P, Bartorelli AL, Tremoli E, Camera M.
Trabattoni D, et al.
JACC Basic Transl Sci. 2022 Apr 13;7(6):525-540. doi: 10.1016/j.jacbts.2022.02.002. eCollection 2022 Jun.
JACC Basic Transl Sci. 2022.
PMID: 35818509
Free PMC article.
Disrupted Functional Connectivity of the Amygdala Predicts the Efficacy of Non-steroidal Anti-inflammatory Drugs in Migraineurs Without Aura.
Wei HL, Xu CH, Wang JJ, Zhou GP, Guo X, Chen YC, Yu YS, He ZZ, Yin X, Li J, Zhang H.
Wei HL, et al.
Front Mol Neurosci. 2022 Feb 24;15:819507. doi: 10.3389/fnmol.2022.819507. eCollection 2022.
Front Mol Neurosci. 2022.
PMID: 35283727
Free PMC article.

Publication types

MeSH terms

Substances

How it works, dosages, side effects, and more

People can take a range of medications for migraine, including nonsteroidal anti-inflammatory drugs such as aspirin. For many, aspirin is an affordable, convenient, and effective migraine treatment.

It is available over the counter (OTC) and on prescription. However, this medication is not suitable for everyone.

This article offers an overview of taking aspirin for migraine, including how it works, dosages, and side effects. It also looks at how it compares with other migraine treatments.

People can take aspirin, a common nonsteroidal anti-inflammatory drug (NSAID), to stop the progression of migraine. Typically, a person takes a single dose as soon as they feel symptoms developing. The aim is to prevent the progression of the migraine to reduce pain.

Aspirin may also work as a preventative medication when taken daily at lower doses, although evidence on the effectiveness of this approach is mixed.

Aspirin works by blocking an enzyme that makes the body produce prostaglandins, which are compounds with many bodily functions, including inflammation and pain processes. By stopping this production process, aspirin can control pain and inflammation.

People generally use aspirin for mild-to-moderate migraine that does not trigger nausea or vomiting, as vomiting may mean they do not absorb the medication. Those who experience vomiting during migraine episodes may need antiemetics to ensure the body can absorb other medicines.

A 2020 review states that people using aspirin as a treatment for current migraine symptoms can take a single high dose between 900–1,300 milligrams (mg).

The review also states it is possible to take aspirin daily at lower doses to prevent recurring episodes. However, the evidence is mixed for this approach. People who wish to try this method can take between 81–325 mg per day.

A 2014 review of previous research found that taking 1,000 mg of aspirin was comparable to a standard dose of sumatriptan in terms of acute pain relief. Aspirin also caused fewer side effects than sumatriptan.

In the review, out of 2,027 participants from six studies, 24% were pain-free 2 hours after taking aspirin, compared to 11% taking a placebo.

Many people who take aspirin tolerate it well at safe dosages. However, as with all NSAIDs, it can lead to side effects.

While the 2014 review found that aspirin had fewer side effects than sumatriptan, aspirin has the highest risk of side effects out of all NSAIDs available for migraine.

The most common side effects of aspirin are:

digestive irritation
indigestion
nausea

Less commonly, people can experience:

worsened asthma symptoms
shortness of breath
tinnitus

Rarely, severe adverse effects include:

ulcers
gastrointestinal bleeding
severe allergic reactions

A 2018 review cautions against using OTC pain medications for long periods. If a person experiences migraine episodes or headaches frequently, they may need to consider other options.

Some people should not take aspirin, including:

children under 12 years old
children and adolescents with symptoms of flu or chickenpox
people who are allergic or sensitive to NSAIDs
people with stomach ulcers
people with bleeding disorders, such as hemophilia
people who are pregnant, unless otherwise instructed by a doctor

Children and adolescents should not use aspirin because the medication has links with Reye’s syndrome. People with this condition may develop swelling in the brain, which can lead to coma and even death.

People should speak with a doctor before trying aspirin if they have a preexisting condition, such as:

asthma
digestive conditions
liver or kidney disease
glucose-6-phosphate dehydrogenase deficiency, as aspirin may trigger anemia in these individuals

Certain medications may also interact with aspirin. If someone takes existing medicines, speak with a doctor or pharmacist before using aspirin.

NSAIDs

NSAIDs are a first-line treatment for mild-to-moderate migraine. Examples that doctors and pharmacists may recommend include:

ibuprofen (Advil, Motrin)
naproxen
diclofenac

Naproxen is the slowest acting NSAID, but it has the longest duration of action. Aspirin works more quickly, but does not last as long.

Acetaminophen

Acetaminophen (Tylenol) is not an NSAID, but a common OTC pain medication that may help with migraine pain.

A 2018 review notes that acetaminophen is not as effective as NSAIDs for treating migraine. However, it may cause fewer side effects in some people.

Those who cannot take other types of migraine medication may instead try a combined regimen of acetaminophen, aspirin, and caffeine.

Triptans

People with moderate-to-severe migraine may require triptans. These medications work specifically for migraine, including drugs such as:

sumatriptan
almotriptan
zolmitriptan

The 2014 review found that sumatriptan and aspirin are similarly effective for migraine. However, they come with their own side effects and risks, particularly if people combine them with medications that affect serotonin levels, such as certain antidepressants.

Other medications for migraine include:

ergots, such as ergotamine and dihydroergotamine
dexamethasone, a steroid that does not reduce immediate pain but can reduce the frequency of migraine episodes
calcitonin gene-related peptide antagonists
opioids, although the 2018 review notes these should be a last resort

Sometimes, migraine headaches or episodes are unavoidable. While people do not always understand what causes them, they can try to identify specific triggers and find relief with diet or lifestyle changes.

Keep a migraine diary to record symptoms when they occur, alongside any factors that may have contributed to migraine that day. Over time, a person may notice a pattern.

Factors that may lead to migraine include:

stress
hormonal changes
specific foods, such as cheese or chocolate
strong smells or tastes
bright lights
skipped meals
weather changes
being too hot
too much or not enough sleep
drinking alcohol
cigarette smoke
exercise
sex

In some people, muscle tension can also trigger migraine headaches. However, if a person’s headaches often precede neck pain, they may be experiencing cervicogenic headaches. These feel similar to migraine, but nerve, muscle, or bone issues in the neck are the cause.

Depending on a person’s triggers, they may be able to reduce the frequency of migraine episodes with:

yoga
relaxation training
physical therapy
biofeedback
sleep aids such as melatonin
dietary changes
stopping smoking or drinking

Migraine pain can be severe, but severe pain can sometimes indicate another condition that requires medical treatment.

Anyone experiencing the following should seek emergency help:

a headache that feels excruciating or comes on suddenly
a severe headache that gets increasingly severe
seizures
symptoms of a severe allergic reaction, such as swollen airways and trouble breathing

It is also important to speak with a doctor promptly if:

a person is over 50 years old when migraine episodes begin
they have symptoms of other disorders, such as high blood pressure, weight loss, or other pain
they have signs of infection, such as fever

People experiencing these symptoms may need a referral to a specialist.

If a person has any new symptoms while taking aspirin, stop taking it and speak with a doctor as soon as possible.

Aspirin can be an effective and affordable migraine treatment. People often use it in a single high dose to prevent migraine headaches or episodes from getting worse.

However, this medication is not suitable for everyone, so check with a doctor before taking it. A healthcare professional or pharmacist can recommend the best dosage and advise on alternatives if aspirin triggers side effects or is not effective.

Pain relief for migraine

painkillers, and most of them are sold without prescription. Below we will review the rules for the relief of migraine attacks , which will help you navigate the rich variety of analgesics and abandon undereffective drugs.
A stepwise approach to treatment of migraine attacks is currently preferred .
In this case, the patient starts with the cheapest, safest, and proven drugs and moves up the ladder to the next class of drugs only when needed.
This method does not deny an individual approach to each patient, but, on the contrary, makes it possible to find the most suitable drug for each patient. It is suggested that if a particular remedy fails to relieve pain in three attacks, the next attack should immediately begin at a higher level.
Moreover, many patients have seizures of varying intensity . For example, in most patients , menstrual migraine attacks (those that occur 1-2 days before or on the first or second day of menstruation) tend to be more severe. Such patients need anesthesia of higher levels at the very beginning of a menstrual attack.
Ideally, requires rest or sleep after taking the medicine.
For patients who need to stay at work or do important things at home, it is better to choose drugs that do not affect concentration.
I. First-line analgesic
Non-specific analgesic ± antiemetic
High doses of analgesic are usually needed to relieve a migraine attack , since the absorption of drugs may be slowed down due to gastrostasis.
1a. Simple analgesic ± antiemetic
The gold standard for migraine pain relief is acetylsalicylic acid.
A high dose of 1000 mg is needed to stop a migraine attack. 2 tablets of 500 mg. A soluble form of acetylsalicylic acid is preferred.
The effectiveness of aspirin was shown in a recent systematic review by the Cochrane Society, a standard-setting organization in the world of evidence-based medicine.
An alternative to acetylsalicylic acid is ibuprofen at a dose of at least 400-600 mg. Clinical experience shows that patients usually take lower doses of 200-400 mg, which is why they are disappointed with this drug. Acetylsalicylic acid and ibuprofen can be taken up to 4 times in 24 hours.

• naproxen 750-825 mg once, with an option to take another 250 mg 2 times over the next 24 hours;
• diclofenac potassium 50-100 mg, daily dose may be up to 200 mg. This drug has a definite advantage.
Due to the rapid development of gastrostasis and consequent slowing of drug absorption during a migraine attack, resorbable or soluble forms of painkillers are preferred. In Russia, none of the painkillers is registered in the form of lingual tablets. Diclofenac Potassium is available as a soluble powder at the same time, taking gives a faster effect . In 2010, data from a study were published that showed that administration of soluble diclofenac potassium leads to an effective reduction in pain intensity after 30 minutes. Such a rapid effect may be due to the fact that the maximum concentration of soluble diclofenac potassium in plasma is reached 15 minutes after administration. The duration of the effect of the drug in the study exceeded 24 hours.
Paracetamol is less effective and should not be used as a drug of first choice for the relief of migraine attacks.
All pain medications must be combined with prokinetic . Such drugs fight gastrostasis during a migraine attack, accelerate the passage of the analgesic from the stomach to the intestines, which makes it possible to accelerate the onset of their analgesic effect and minimize irritation of the gastric mucosa.
For this purpose you can use:
• metoclopramide 10 mg (1 tablet). The drug is available under trade names cerucal , metoclopramide and raglan ;
• domperidone 10-20 mg (1-2 tablets). The drug is available under the trade names domperidone and motilium . The use of domperidone is more preferable, since the drug rarely causes extrapyramidal disorders. If taken later, these drugs also reduce the feeling of nausea.
The analgesic effect of drugs can also be strengthen by adding caffeine . It has been shown that the addition of 130 mg of caffeine to the usual dose of painkillers ( aspirin and paracetamol ) increases the effectiveness of their analgesic action by 40%. Caffeine also improves the absorption of these drugs, speeding up the onset of their effect. That is why the combination non-specific analgesic + prokinetic must be supplemented with caffeinated drink . For example, freshly brewed coffee (200 ml) contains 65-135 mg caffeine, espresso (60 ml) – 100 mg caffeine, tea (200 ml) – 40-60 mg, hot cocoa (200 ml) – 14 mg, cola (330 ml) – 30-50 mg, Red Bull™ (230 ml) – 80 mg caffeine . The analgesic effect of can also be enhanced by the addition of glucose . That is why in Western countries it is recommended to dissolve aspirin in a sweet caffeine-containing carbonated drink.
Contraindications: specific contraindications to non-steroidal anti-inflammatory drugs (eg gastric ulcer). Avoid giving aspirin to children under 12 years of age. Metoclopramide is also not used in children.
1b. Combination analgesic ± antiemetic
Combination pain medications are also registered in Russia. All these preparations contain caffeine . The drug Citramon is very popular. It contains: paracetamol 180 mg + caffeine 30 mg + acetylsalicylic acid 240 mg. The preparation askofen P is practically similar in composition to citramon. To achieve the optimal analgesic effect, it is advisable to take 2 tablets of Citramon.
It should be noted that the European Guidelines for the treatment of migraine attacks do not include all combined preparations. At the same time, the drug Excedrin 9 is used in the USA0042, almost completely corresponding in composition to citramon. In case of insufficient effectiveness of single-component analgesics, the use of Citramon can be recommended, but only for those patients who do not need to take this drug more than 2 times a week.
1c. Non-specific analgesic in suppositories – antiemetic
Pain medications are also available in the form of suppositories. This helps ensure they are well absorbed during nausea and vomiting. Available as rectal suppositories voltaren 100 mg (diclo-fenac). Up to 200 mg can be used in 24 hours.
Clinical experience shows that many patients seek medical advice when their usually combined analgesics are ineffective. In this case, there is usually an increase in the dose and frequency of taking painkillers, which in the short term leads to the formation of drug-induced headache . That is why, in case of insufficient effectiveness of the first stage of anesthesia, it is necessary to transfer the patient to the second stage – specific anti-migraine analgesics. Today, in the era of the advent of generic triptans , these drugs are becoming more affordable for different categories of patients.
II. Second stage pain relief
Specific anti-migraine analgesics
Specific anti-migraine analgesics – triptans – are selective 5-HT1 receptor agonists. Although all triptans have the same site of application, some patients respond to only 1 or 2 different drugs, so the final choice of drug must be left to the patient. This choice may be influenced by the rate of onset of the analgesic effect, as well as financial reasons. Ideally, each triptan should be taken in 3 attacks before a final conclusion can be drawn about its effectiveness.
Triptans should be taken after the end of the aura. At the same time, their effectiveness is maximum in the case of early administration (no later than 2 hours after the onset of headache). Pain returns within 48 hours in 20–50% of patients. Triptan may be combined with the prokinetic drug metoclopramide or domperidone. Triptans should only be taken if the patient is completely certain that the attack is a migraine. If the pain grows slowly and there is no such certainty, you need to start with a non-specific analgesic.
Sumatriptan was the first in this class. Today it is the most researched drug, in addition, generic sumatriptan drugs have appeared, the cost of which is significantly lower than the cost of original drugs.
All triptans currently registered in Russia are presented in the table.
In a study conducted in Russia, in the case of early use of sumamigren, a significant decrease in headache and associated symptoms ( nausea , photophobia , phonophobia ) was observed already 1 hour after taking sumamigren. Thus, the intensity of headache decreased from 7.1±1.7 to 4.9+2.1 points (on a 10-point scale), nausea — from 5.4+2.7 to 3.7+ 2.1, photophobia — from 5.7+2.3 to 3.7+1.7, phonophobia — from 5.3±2.3 to 3.4±2.2 points. The intensity of headache with concomitant symptoms significantly decreased 2 and 6 hours after taking sumamigren: after 2 hours, the intensity of cephalalgia was 2.7+1.3, and after 6 hours it was 1.3+1.4 points (Fig. 1 and 2).
In view of such high efficiency, comparable with the effect of the original drug (direct comparative studies have not been conducted), an important advantage of sumamigren is its significantly lower cost – approximately 150-180 rubles per package of 2 tablets of 50 mg.
Naratriptan is slower acting than other drugs and may be used if other drugs cause side effects.
Contraindications: Triptans are contraindicated in cases of uncontrolled hypertension, significant risk factors for cardiovascular disease (history of stroke or myocardial infarction, advanced age, anti-phospholipid syndrome). In the absence of these contraindications, the risk associated with taking triptans is very low.
In case of ineffectiveness of the second stage of anesthesia, it is necessary to confirm the diagnosis, pay attention to the time of taking the drugs, and suggest preventive treatment.
III. Third-degree pain relief
Combination of simple analgesic and triptan
There is evidence that the combination of sumatriptan 50 mg and naproxen 500 mg may be more effective than sumatriptan alone. Such a scheme can be offered, for example, to patients who experience pain or discomfort in the neck during an attack, as well as during menstrual migraine attacks, if the patient also experiences periodic abdominal pain.
Classic method for migraine relief:
• Acetylsalicylic acid 1000 mg + motilium 10 mg + sweet caffeine-containing drink.
• If pain is not relieved after 45 minutes, triptan (1 tablet) should be taken.
• It is recommended to take a triptan immediately if a non-specific analgesic has not been effective for 3 attacks in a row.
In the case of migraine with aura, aspirin should be taken after the onset of the aura, and triptans – after onset of headache .
- Acupuncture for migraine
- Reflexology in the clinic
- How to help a child during a migraine attack
- How to treat panic attacks in pregnant women
- Causes of migraine
- Migraine : symptoms and treatment
- Migraine in women and menstrual migraine
- Treatment migraine in the clinic. Veyna
- Tension headache
- Abuse headache
- Medicines for migraine and headaches
- Treatment of depression
- Treatment of insomnia in the clinic
- Paid neurologist
- Children’s neurologist
- How to deal with panic attacks?
- Treatment of panic attacks and panic attacks in Moscow
- Psychotherapy in the clinic
- Headache – treatment
- Treatment of VSD and panic attacks
- Treatment of facial pain
- Trigeminal nerve treatment
- Neurology Center
- Psychotherapists of the clinic
- Why do you need a consultation with a neurologist in Moscow?
- Pain management
Migraine medication
There are over 200 types of headaches and many possible triggers that cause them. The range of drugs for headaches and migraine attacks is large, so choosing the best one is difficult. What helps to quickly and effectively relieve pain? Is there a perfect migraine cure? In fact, only the patient himself can give an answer, the reaction of the body to each drug is very individual.
To facilitate the decision on the choice of drugs, we can use the following conclusion – for a migraine attack, combined analgesics (acetylsalicylic acid, paracetamol, ibuprofen and caffeine) are the drugs of first choice. This conclusion is the result of serious research by headache companies in German-speaking countries (German Migraine and Headache Society, Austrian Headache Society, Swiss Headache Society).
Ibuprofen
Ibuprofen is a modern active ingredient for the treatment of pain. It is used very frequently and is recommended by the experts of the German Migraine and Headache Society (DMKG) as the first choice for the treatment of migraine and tension headache. Ibuprofen may also be used as a suppository for associated nausea. A good effect from it is noticeable with mild or moderate pain, but it is especially useful if inflammation is observed at the same time. The recommended dosage for acute headache in self-treatment is 400 mg.
Paracetamol
Paracetamol is a long-acting analgesic. It is widely used throughout the world and has shown good results in mild to moderate pain. In acute headache, doses of 500-1000 mg are recommended, depending on its intensity. Since paracetamol also has an antipyretic component and is well tolerated at the recommended age dosage, it is often used in children. For migraine attacks with vomiting, paracetamol can be used as a suppository. The mechanism by which the drug relieves headache pain is unclear.
Acetylsalicylic acid
Acetylsalicylic acid is a classic analgesic. For headaches, the drug has been considered the drug of choice for decades. In addition to the analgesic component, aspirin is used for its blood-thinning effect in low doses to prevent circulatory disorders. The recommended dose for adults with acute headache is 1000 mg (depending on the severity of the pain)
Caffeine for headache
Espresso with lemon at the start of a migraine attack? Could this really help? In fact, caffeine can relieve headaches, which is now scientifically proven. But anyone who thinks they can just “wash down” a headache pill with a cup of espresso is wrong. Because the amount of caffeine varies greatly depending on the type of coffee and its preparation.
Caffeine is widely used as an active ingredient in pain relievers in combination with paracetamol and aspirin for headaches. Here it not only acts as an anesthetic, but also enhances the effectiveness of other components. In addition, caffeine acts as a vasodilator, a factor that can help a headache sufferer. In general, adding 100mg of caffeine to a pain reliever can provide an additional analgesic effect, roughly equivalent to doubling the analgesic dose. Caffeine enters our bloodstream very quickly – after 30-45 minutes it can already be detected in the blood. The substance is distributed in the body, remains there for about four hours, and then again excreted in the urine. Today, scientists are discussing whether caffeine itself can have an analgesic effect?
Combination preparations for migraine
In the treatment of migraine, the combination of caffeine with classic pain relievers such as aspirin, paracetamol and ibuprofen shows good results. In this case, caffeine, among other things, acts as a kind of “accelerator”. By enhancing the absorption of active ingredients into the blood, it allows you to achieve a faster effect. Another advantage in the treatment of headaches with combination preparations is that the amount of active ingredient of the individual substances per tablet can be kept lower than in the respective individual preparations.
New clinical data show that ibuprofen 400 mg plus medicated caffeine 100 mg is faster and more effective than ibuprofen alone. The combination outperforms ibuprofen alone by 40 percent.