Migraine

Dr MacGregor spoke about the more routine use of aspirin in headache, and specifically migraine. In most developed countries about a third of people identified as having migraine do not bother consulting their doctors. In Japan the figure is as high as 69% because it carries a huge social stigma.

aspirin is very effective for headache, and, said Dr MacGregor, for migraine, in which there is also disturbance in appetite, alertness, tolerance to light, noises and smells and fluid imbalance. aspirin helps in all these changes by being more than a painkiller. It is anti-inflammatory, inhibits platelet aggregation and subsequent serotonin release, and has central effects. Achieving high blood levels of aspirin quickly gives good pain relief before the delayed gastric emptying that occurs in the attack impairs its absorption of oral medication. The correct dose is 900 to 1000mg (three standard UK pills) preferably of a soluble formulation as this achieves high levels more rapidly than solid tablets.

Dr MacGregor's double blind cross over study in 4 migraine centres randomised patients to a new formulation of aspirin mouth dispersible 900 mg versus placebo. 80 per cent of the trial patients were using triptan prescriptions and a similar percentage described their usual attacks as severe. After 30 minutes there was a statistical difference between the two treatments that remained for at least 2 hours (48% had complete relief on aspirin vs 19% on placebo). Mouth dispersible aspirin also relieved the symptoms of dislike of light and sound and speeded up return to normal function.

Other studies have shown that combining aspirin with oral metoclopramide is as effective as a sumatriptan, is better tolerated and much cheaper. People taking aspirin and/or metoclopramide can repeat the doses for incomplete effect: they cannot do so with most triptans.

The British Association for Study of Headache advises that people with migraine take aspirin 900mg in soluble formulation early in the attack, and to add metoclopramide 10mg or domperidone 20 mg if needed. Mouth dispersible aspirin produces similar absorption to soluble formulations with the advantage that it can be taken without water. Dr MacGregor preferred domperidone to metoclopramide, as she felt that it was less likely to give extrapyramidal side effects.