Question

Can aspirin be used for migraine prophylaxis?

Response from Nancy Hope Goodbar, PharmD 

 

Assistant Professor of Pharmacy Practice, Presbyterian College School of Pharmacy, Clinton, South Carolina

The theorized mechanism of migraine prevention using antiplatelet therapy is centered on the possible platelet hyperaggregability in patients who suffer from migraines.[1] The first evaluation of aspirin for migraine prophylaxis was published in the Lancet in 1978, and this pilot study showed an approximate 50% reduction in headache frequency in 9 out of 12 patients.[2] Subsequent trials have produced conflicting results on the overall benefit of migraine prophylaxis with aspirin. Aspirin is currently classified by American Academy of Neurology (AAN) and the American Headache Society (AHS) recommendations as level U, indicating that there is inadequate or insufficient evidence to support or refute its use as migraine prevention therapy.[3]

Recent, relevant studies evaluating aspirin for migraine prophylaxis are few and have not shed any light on when aspirin might be an option in patients with episodic migraine. Aspirin 300 mg daily was compared with metoprolol 200 mg daily, a level A-classified migraine prevention therapy, and was found to be inferior in reducing migraine frequency in the study population.[4] The study investigators also noted that the patients treated with aspirin had a 30% response rate, which is consistent with the response of placebo-treated patients in other studies evaluating migraine prophylaxis therapies.[4]

Another study compared aspirin 100 mg and vitamin E with placebo and vitamin E in a population of middle-aged women and found a nonsignificant decline in migraine frequency.[5] Alternatively, a retrospective study presented at the European Headache and Migraine Trust International Congress evaluated aspirin prophylaxis in comparison with any other preventative therapy in patients specifically with migraine with aura. This evaluation showed statistically significant reductions in migraine crises with aura in patients, regardless of age, sex, or aura type.[6]

Secondary to the current level U classification in the AAN/AHS guidelines for migraine prophylaxis, combined with the conflicting evidence from the medical literature, there does not seem to be an evidence-based reason to use aspirin for migraine prophylaxis. The most promising data comes from the benefit seen in patients suffering from migraine with aura; however, a well-designed, prospective study with a larger sample size would have to be done to verify the outcome of the retrospective analysis before it would be clinically supported.

References

  1. Masel BE, Chesson AL, Peters BH, Levin HS, Alperin JB. Platelet antagonists in migraine prophylaxis. A clinical trial using aspirin and dipyridamole. Headache. 1980;20:13-18. Abstract 
  2. O'Neill BP, Mann JD. Aspirin prophylaxis in migraine. Lancet. 1978;2:1179-1181. Abstract 
  3. Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E; Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78:1346-1353. Abstract 
  4. Diener HC, Hartung E, Chrubasik J, et al. A comparative study of oral acetylsalicylic acid and metoprolol for the prophylactic treatment of migraine. A randomized, controlled, double-blind, parallel group phase III study. Cephalalgia. 2001;21:120-128. Abstract 
  5. Bensenor IM, Cook NR, Lee IM, Chown MJ, Hennekens CH, Buring JE. Low-dose aspirin for migraine prophylaxis in women. Cephalalgia. 2001;21:175-183. Abstract 
  6. Savi LT, Condello V, Bert F, Pinessi L. Prophylaxis of migraine with aura: a place for acetylsalicylic acid. J Headache Pain. 2013;14(Suppl 1):P195.
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