Aspirin makes the grade for migraine relief

You may want to rummage a bit deeper in your medicine cabinet the next time you get a migraine.

That often-overlooked bottle of aspirin (hidden behind the band-aids and dental floss) can provide potent pain relief for your headaches, say researchers. In fact, a single high dose of aspirin (up to 1000 mg) can work as well as a lower-dose prescription drug.

These findings come from a new review of studies on using aspirin for moderate to severe migraines. Several studies over the years have found that aspirin can improve migraine symptoms such as pain, nausea, and uncomfortable sensitivity to light or sound. But detailed reviews of these studies have been lacking.

To fill this gap, researchers searched through the medical literature and found 13 high-quality studies on using aspirin for migraines. They then pooled the data from these studies to see what conclusions they could draw from this larger body of research.

Most strikingly, aspirin alone or combined with an anti-nausea drug called metoclopramide worked just as well for migraines as 50 milligrams of the prescription drug sumatriptan. Aspirin plus metoclopramide also matched a 100 mg dose of sumatriptan on most measures, although it was slightly less effective in completely relieving pain after two hours.

Overall, roughly 1 in 2 people (52 percent) who took a single dose of aspirin (900 mg or 1000 mg) rated their pain as having improved to mild or better within two hours. And 1 in 4 people (24 percent) said that their pain had completely disappeared. In comparison, only 1 in 3 people (32 percent) who took an inactive treatment (a placebo) said their pain had improved to mild or better, and 1 in 10 (11 percent) reported that their pain had disappeared. People who took aspirin were also more likely to see improvements in their nausea and sensitivity to light or sound.

But these findings may actually underestimate how well aspirin works. This is because many people take painkillers when they first get migraine symptoms, rather than waiting until their pain becomes moderate or severe, as occurred in these studies. Research suggests that taking painkillers early works better than waiting until the pain gets worse. So it could be that aspirin helps more migraineurs when it's used early on.

These studies didn't look at what happens when people frequently take aspirin for migraines. But it's well known that aspirin can irritate the stomach, so frequent use could lead to stomach problems. Also, children and teenagers shouldn't take aspirin for migraines or any other condition, as it can cause a rare but dangerous problem called Reye's syndrome.

What you need to know. The humble aspirin holds its own when it comes to relieving migraines, performing just as well as lower-dose sumatriptan. However, aspirin doesn't work for everyone, and you may find that another medication suits you better. Your doctor can help you explore all your treatment options, both prescription and over the counter.

—Sophie Ramsey, patient editor, BMJ Group

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