Got a migraine? Relief may already be on your medicine shelf

According to a new report in The American Journal of Medicine, published by Elsevier, aspirin can be considered an effective and safe option to other, more expensive medications to treat acute migraines as well as prevent recurrent attacks. A review of randomized evidence suggests efficacy and safety of high dose aspirin in doses from 900 to 1,300 milligrams taken at the onset of acute symptoms. The data also support a lower dose of from 81 to 325 milligrams as a possible preventive option.

“Aspirin provides a possible clinical option for primary healthcare providers to relieve the debilitating symptoms of acute migraine headaches and prevent recurrent attacks. Aspirin’s side effect profile and low cost may also favour its use,” noted senior author Charles H. Hennekens, MD, DrPH, the first Sir Richard Doll Professor & Senior Academic Advisor to the Dean of  the Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL, USA. The investigators reviewed the randomized evidence for high dose aspirin in treatment and low dose aspirin in prevention of migraine headaches.

Migraine headache is the third most common disease in the world affecting about one in seven people. More prevalent than diabetes, epilepsy, and asthma combined, migraine headaches are among the most common and potentially debilitating disorders encountered by primary healthcare providers. Migraines are also associated with an increased risk of stroke. There are effective prescription medications available to treat acute migraine headaches as well as to prevent recurrent attacks. Nonetheless, in the United States many patients are not adequately treated for reasons that include limited access to healthcare providers, lack of health insurance, or high co-pays, which make expensive medications of proven benefit unaffordable. The rates of uninsured (or underinsured) have been estimated to be 8.5 percent nationwide and 13 percent in Florida. Furthermore, for all patients, the prescription drugs may be poorly tolerated or contraindicated.

Professor Hennekens mused that, “If aspirin were only half as effective, 10 times more expensive, and available by prescription, then perhaps patients and, possibly some of their healthcare providers, would take it more seriously.”

“Despite the fact that aspirin is an over-the-counter drug,” Dr. Hennekens cautioned, “as is the case for any drug used long term, it should be prescribed by a healthcare provider.”

Joseph S. Alpert, MD, Editor-in-Chief of The American Journal of Medicine and Professor of Medicine, University of Arizona Department of Medicine, Tucson, AZ, USA, commented in an accompanying editorial, “My take home message from this thoughtful and carefully researched review is that physicians should always try the simple and inexpensive high dose aspirin regimen as the initial therapeutic attempt for migraine headache control. If aspirin works to abort or ameliorate the headaches, then it should be tried as a prophylactic measure to see if it can prevent the occurrence of these debilitating headaches. Hopefully, this would lead to less disability and loss of employment time for these patients who are so common in the US and throughout the world.”

Notes 
The article is “Aspirin in the Treatment and Prevention of Migraine Headaches: Possible Additional Clinical Options for Primary Healthcare Providers,” by Bianca Biglione, BS, BA, Alexander Gitin, BS, Philip B. Gorelick MD, MPH, and Charles Hennekens, MD, DrPH (https://doi.org/10.1016/j.amjmed.2019.10.023). The editorial is “A common drug may help patients with debilitating migraine headaches,” by Joseph S. Alpert, MD (https://doi.org/10.1016/j.amjmed.2019.11.002). They will appear in The American Journal of Medicine, volume 133, issue 4 (April 2020) published by Elsevier.

About The American Journal of Medicine
The American Journal of Medicine, known as the “Green Journal,” is one of the oldest and most prestigious general internal medicine journals published in the United States. The official journal of The Association of Professors of Medicine, a group comprised of chairs of departments of internal medicine at 125-plus US medical schools, AJM publishes peer-reviewed, original scientific studies that have direct clinical significance. The information contained in this article in The American Journal of Medicine is not a substitute for medical advice or treatment, and the Journal recommends consultation with your physician or healthcare professional. www.amjmed.com

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray’s Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com