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Aspirin is First‐Line Treatment for Migraine and Episodic Tension‐Type Headache Regardless of Headache Intensity
Author(s) -
Lampl Christian,
Voelker Michael,
Steiner Timothy J.
Publication year - 2012
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/j.1526-4610.2011.01974.x
Subject(s) - triptans , migraine , medicine , aspirin , anesthesia , tension headache , pediatrics , physical therapy
Objectives.— (1) To establish whether pre‐treatment headache intensity in migraine or episodic tension‐type headache (ETTH) predicts success or failure of treatment with aspirin; and (2) to reflect, accordingly, on the place of aspirin in the management of these disorders. Background.— Stepped care in migraine management uses symptomatic treatments as first‐line, reserving triptans for those in whom this proves ineffective. Stratified care chooses between symptomatic therapy and triptans as first‐line on an individual basis according to perceived illness severity. We questioned the 2 assumptions underpinning stratified care in migraine that greater illness severity: (1) reflects greater need; and (2) is a risk factor for failure of symptomatic treatment but not of triptans. Methods.— With regard to the first assumption, we developed a rhetorical argument that need for treatment is underpinned by expectation of benefit, not by illness severity. To address the second, we reviewed individual patient data from 6 clinical trials of aspirin 1000 mg in migraine (N = 2079; 1165 moderate headache, 914 severe) and one of aspirin 500 and 1000 mg in ETTH (N = 325; 180 moderate, 145 severe), relating outcome to pre‐treatment headache intensity. Results.— In migraine, for headache relief at 2 hours, a small (4.7%) and non‐significant risk difference (RD) in therapeutic gain favored moderate pain; for pain freedom at 2 hours, therapeutic gains were almost identical (RD: −0.2%). In ETTH, for headache relief at 2 hours, RDs for both aspirin 500 mg (−4.2%) and aspirin 1000 mg (−9.7%) favored severe pain, although neither significantly; for pain freedom at 2 hours, RDs (−14.2 and −3.6) again favored severe pain. Conclusion.— In neither migraine nor ETTH does pre‐treatment headache intensity predict success or failure of aspirin. This is not an arguable basis for stratified care in migraine. In both disorders, aspirin is first‐line treatment regardless of headache intensity.