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Treating Migraine: The Case for Aspirin

High-dose aspirin is an effective treatment for acute migraine. So why aren’t more clinicians recommending it?

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PRACTICE CHANGER

Recommend aspirin 975 mg (three adult tablets) as a viable firstline treatment for acute migraine. Consider prescribing metoclopramide 10 mg to be taken with aspirin to markedly decrease associated nausea and help achieve maximum symptom relief.1

STRENGTH OF RECOMMENDATION

B: Based on a Cochrane meta-analysis of 13 good-quality, randomized controlled trials (RCTs).1

ILLUSTRATIVE CASE

During a routine physical, a 37-year-old patient asks you what she should take for occasional migraine. She describes a unilateral headache with associated nausea, vomiting, phonophobia, and photophobia. What medication should you recommend?

Migraine headache affects more than 37 million Americans.2 Women are three times more likely than men to experience migraine, with the highest prevalence among those ages 30 to 50.3,4 More than 50% of patients report that episodes cause severe impairment, resulting in an average loss of four to six workdays each year due to migraine.5,6

Do you recommend this low-cost option?

Although many patients try OTC headache remedies for migraine, when they do seek medical care for this condition, most (67%) turn to their primary care provider.7 But despite a 2010 Cochrane review showing aspirin’s efficacy for acute migraine,8 our experience—based on discussions with physicians at numerous residency programs—suggests that family practice providers are not likely to recommend it.

Further evidence of the underuse of aspirin for migraine comes from a 2013 review of national surveillance studies,5 which found that in 2009, triptans accounted for nearly 80% of antimigraine ­analgesics prescribed during office visits.5 Thus, when the Cochrane reviewers issued this update of the earlier meta-analysis, we welcomed the opportunity to feature a practice changer that might not be getting the “traction” it deserves.

Continue reading for the study summary...

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