What is the effect of Acetylsalicylic acid (Aspirin) on migraines?

From the Guidelines

Aspirin is an effective treatment for migraines, and a combination of aspirin, acetaminophen, and caffeine is recommended for the abortive treatment of migraine, with a number needed to treat of 9 for pain freedom at 2 hours and 4 for pain relief at 2 hours. The benefits of aspirin outweigh the risks, as no serious adverse events occurred, and the adverse events reported were mild, consistent with what would be expected from the individual components 1. Aspirin works by inhibiting enzymes called cyclooxygenases (COX), which prevents the production of prostaglandins that cause pain, inflammation, and fever. It also reduces platelet aggregation, which may help improve blood flow in constricted vessels during migraines.

• Key points to consider when using aspirin for migraines include:
  • Typical dose: 500-1000 mg at the first sign of headache, which can be repeated every 4-6 hours if needed (not exceeding 4000 mg daily)
  • Potential side effects: stomach irritation, which can be minimized by taking aspirin with food or using enteric-coated formulations
  • Contraindications: bleeding disorders, aspirin allergies, or those taking blood thinners
  • Alternative options: other preventive medications may be more appropriate for frequent migraines For some people, taking aspirin at the first warning sign of a migraine (during the "aura" phase) can prevent the headache from fully developing. However, the evidence for aspirin as a preventive treatment for migraines is insufficient to recommend for or against its use 1.
• Other treatment options for migraines include:
  • Triptans
  • CGRP inhibitors (gepants)
  • Topiramate
  • Valproate
  • Eptinezumab
  • OnabotulinumtoxinA for chronic migraine It is essential to work with a healthcare provider to determine the best treatment plan for individual patients, taking into account their specific needs and medical history.

From the Research

Aspirin's Effect on Migraines

• Aspirin has been found to be an effective treatment option for acute migraine headaches, with high-dose aspirin (900-1300 mg) taken at the onset of symptoms providing significant pain relief 2, 3.
• The efficacy of aspirin in preventing recurrent migraine headaches is also suggested, with daily doses of 81-325 mg potentially reducing the frequency of migraines 2, 4.
• Aspirin has been compared to other treatments, such as sumatriptan, and has been found to be similarly effective in some cases, with the addition of an antiemetic (e.g. metoclopramide) improving relief of nausea and vomiting 5.
• A combination of acetaminophen, aspirin, and caffeine has also been shown to be effective in the early treatment of migraine, and may be more effective than sumatriptan in some cases 6.

Dosage and Efficacy

• The optimal dosage of aspirin for migraine treatment and prevention is unclear, but doses of at least 325 mg/day may be effective in reducing the frequency of migraines 4.
• High-dose aspirin (900-1300 mg) has been found to be effective in treating acute migraine headaches, while lower doses (81-325 mg) may be effective in preventing recurrent migraines 2, 3.
• The efficacy of aspirin may be influenced by the presence of associated symptoms, such as nausea and vomiting, which can be reduced with the addition of an antiemetic 5.

Safety and Tolerability

• Aspirin has been found to be generally well-tolerated, with adverse events mostly mild and transient 3, 5.
• The risk of adverse events may be slightly higher with aspirin than with placebo, but lower than with some other prescription migraine treatments (e.g. sumatriptan) 5.