doi:10.1136/ebn.8.4.107 2005;8;107- Evid. Based Nurs. Diana E McMillan in acute migraine headacheAspirin, 1000 mg, reduced moderate to severe pain http://ebn.bmj.com/cgi/content/full/8/4/107Updated information and services can be found at: These include:Rapid responses http://ebn.bmj.com/cgi/eletter-submit/8/4/107You can respond to this article at: serviceEmail alertingtop right corner of the article Receive free email alerts when new articles cite this article - sign up in the box at theTopic collections (96 articles) Migraine  (272 articles) Pain  Articles on similar topics can be found in the following collections Notes http://www.bmjjournals.com/cgi/reprintformTo order reprints of this article go to: http://www.bmjjournals.com/subscriptions/ go to: Evidence-Based NursingTo subscribe to on 13 January 2007 ebn.bmj.comDownloaded fromAspirin, 1000 mg, reduced moderate to severe pain in acutemigraine headacheLipton RB, Goldstein J, Baggish JS, et al. Aspirin is efficacious for the treatment of acute migraine. Headache 2005;45:283–92................................................................................................................................QIs a single dose of aspirin, 1000 mg, effective for treatment of acute migraine with moderate to severe pain intensity?METHODSDesign: Randomised, placebo controlled trial.Allocation: unclear concealment.Blinding: blinded (patients).Follow up period: several time points up to 24 hours.Setting: USA.Patients: 485 patients who were 18–50 years of age (mean age37 y, 79% women, 77% white); had experienced migraineheadache, with or without aura, according to InternationalHeadache Society (IHS) criteria; had at least moderate pain; andhad >1 but (6 migraines per month during the previous year.Exclusion criteria included vomiting >20% of the time during anattack; initiation of preventive medication in the past 3 months oruse of alkaloids to treat migraine; use of anticoagulant, gout, orarthritis medications; and previous non-responsiveness tomedication for migraine.Intervention: all patients were trained to identify a qualifyingmigraine attack (based on IHS criteria). Patients who had aqualifying migraine (with or without aura) of at least moderateintensity pain were instructed to take the study medication: 243were allocated to aspirin, 1000 mg (Extra Strength Bayer AspirinCaplets, Bayer Consumer Care Division, Morristown, NJ), and242 were allocated to matched placebo. Patients wereencouraged to wait >2 hours before taking rescue medication.Outcomes: primary outcomes were headache response at 2 hours(change in pain intensity [4 point scale] from moderate or severe atbaseline to mild or none) and freedom from pain. Other outcomesincluded reduction in symptoms of nausea, photophobia, andphonophobia; improvement in functional ability; and adverseevents. Outcomes were based on patient self report diariescompleted at 30 minutes, and 1, 2, 3, 4, 5, 6, and 24 hours.Patient follow up: 401 patients (83%) who took the study medi-cation and had confirmed migraine were included in the analysis.MAIN RESULTSAt 2 hours, more patients who received aspirin had a response andwere pain free compared with patients who received placebo (table).Pain intensity difference scores were higher in the aspirin group from1 hour onward. At 2 hours, more patients in the aspirin group hadresolution of photophobia and phonophobia; the groups did notdiffer for resolution of nausea (table). More patients in the aspiringroup had improved functional ability from 1–6 hours (p,0.001).The groups did not differ for overall adverse events (table).CONCLUSIONAspirin, 1000 mg, reduced pain, photophobia, and phonophobia inappropriately selected patients with moderate to severe acutemigraine pain..............................................................For correspondence: Dr R B Lipton, Depa rtment of Neurology, Albert EinsteinCollege of Medicine, Bronx, NY, USA. [email protected] of funding: Bayer Corporation, Morristown, NJ, USA.CommentaryMigraine headaches are characterised by debilitating, unilateral,throbbing pain aggravated by routine activity and associatedwith nausea, vomiting, photophobia, and phonophobia.1An esti-mated 12% of the population have migraines, and more than half ofpatients treat this condition with over-the-counter (OTC) medication.2Liptonet al offer a needed evaluation of aspirin in caplet form for acute migraine.Notably, the study sample did not exclude patients bedridden by migraine,a common limitation of previous OTC migraine medication trials.The authors reported that aspirin was statistically superior to placebofor most reported migraine pain and symptom endpoints. However, theclinical effects of treatment translate more modestly to 18% moreresponders and 14% more pain-free patients compared with placeboat 2 hours, with wide confidence intervals noted for numbers needed totreat (abstract table). Furthermore, 80% of patients who took aspirin stillhad at least mild pain at 2 hours, and recurrence rates at 6 and 24 hourswere not different between groups. Marked attrition (173/401) at the 24hour recurrence endpoint and the lack of a crossover design, asrecommended by the IHS, were 2 noted study limitations.Health professionals need to ensure that symptoms of acute migraine aredifferentiated from other serious health conditions such as hypertension orbrain tumour, recognise the limitations of OTC medications for treatingchronic or severely debilitating migraine attacks, and be aware of thepotential for medication-induced headaches and other side effects if OTCtreatments are overused. With these considerations in mind, the study byLipton et al supports the recommendation of a 1000 mg dose of caplet formaspirin in appropriately selected patients as an inexpensive, potentiallybeneficial OTC treatment option for patients with acute migraine headache.Diana E McMillan, RN, PhDFaculty of Nursing, University of ManitobaWinnipeg, Manitoba, Canada1 Wenzel RG, Sarvis CA, Krause ML. Pharmacotherapy 2003;23:494–505.2 Lipton RB, Stewart WF, Diamond S, et al. Headache 2001;41:646–57.Aspirin, 1000 mg, v placebo for acute migraine with moderate to severe pain*Outcomes at 2 hours Aspirin Placebo RBI (95% CI) NNT (CI)Response 52% 34% 53% (21 to 94) 6 (4 to 12)Pain free 20% 6% 233% (83 to 513) 8 (5 to 14)Resolution of nausea 52% 43% 21% (22 to 49) Not significantResolution of photophobia 30% 14% 114% (44 to 221) 7 (5 to 13)Resolution of