Combining sumatriptan for the treatment of acute migraine.

Research indicated that aspirin was effective for acute migraines both as a solitary modality and in combination with other drugs. Aspirin functions to irreversibly inhibit cyclooxygenase enzymes (COX-1 and COX-2), which results in decreased prostaglandin synthesis and a reduction in pain and inflammation. Studies to date have confirmed the beneficial effects of aspirin on migraine without aura, but its effects on migraine with aura are unclear and require further investigation.

Research on the effectiveness of aspirin in the treatment of migraine alone or in combination with other drugs is ongoing. Metoclopramide is an antiemetic that is often prescribed alongside high-dose aspirin to treat acute migraine. A meta-analysis of 13 randomized control trials (RCTs) comparing 1,000mg of aspirin (with and without 10mg of metoclopramide) to placebo or sumatriptan (Imitrex; 50mg or 100mg), found no significant differences between aspirin and 50mg or 100mg of sumatriptan doses when assessing reduced head pain or complete remission of pain.

A study assessing the effects of aspirin alone found that, when administered between the ranges of 900 mg to 1000mg, aspirin was effective in providing relief at 2 hours for between 48% and 52% of participants, compared with between 19% and 34% in the placebo group. 8 An RCT of 433 patients demonstrated that 1000mg of aspirin produced similar benefits when compared to 50mg of sumatriptan.9 This was further supported by recent research concluding that high-dose aspirin administered between the ranges of 900mg to 1300mg was effective in patients with migraines when compared with alternative, more expensive therapies such as beta-blockers or antiseizure drugs.

Many of these studies also reported a decrease in the frequently concomitant symptoms of nausea, photophobia, and phonophobia in patients receiving 900mg to 1300mg of aspirin.1 Furthermore, randomized evidence on the side effects of aspirin showed promising results in comparison to both traditional, nonselective NSAIDs, and cyclooxygenase-2 inhibitors.

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