Intravenous aspirin effective and safe for migraines and severe headaches


Intravenous aspirin effective and safe for migraines and severe headaches

Patients who are hospitalized with severe migraine or headache may benefit from the intravenous administration of aspirin, say researchers in a study published in the medical journal Neurology. In the UK intravenous aspirin is only available on a "named patient" basis; in the USA it is not readily available.

Peter J. Goadsby, MD, PhD, study author, who works in the Department of Neurology, University of California, San Francisco, and is also a member of the American Academy of Neurology, said:

Our results show it could be a cost-effective, safe and easy to use treatment for people hospitalized for headache or migraine." A "named patient" program is only available to people who have tried all other alternative treatments and do not qualify for a clinical trial.

In this study the investigators examined the medical records of 168 individuals aged between 18 and 75 years - they had all been hospitalized for headache and given IV (intravenous) aspirin. 117 of them were women. 165 of them had chronic daily headache - meaning a headache for at least 15 days per month for three months. The majority of them were also diagnosed with migraine.

They were given 1-gram doses of aspirin, with an average of five doses. 6% of them had undesirable side effects, none of which were deemed severe, the researchers report. Examples included vomiting, nausea and IV-insertion pain.

86 of the patients wrote hourly diaries about their pain before, during and after IV-aspirin treatment. They were asked to rate their headaches on a scale from 1 to 10:

  • Mild headache = 1 to 3 points
  • Moderate headache = 4 to 7 points
  • Severe headache = 8 to 10 points
The researchers also took note of patients' comments and nurses' notes when rating IV aspirin effectiveness.

They found that:

  • For at least 25% of the time, patients rated their headache scores 3 points lower than usual. So somebody who would have had a severe headache would experience a moderate one while on IV aspirin therapy.
  • For about 40% of the time, patients reported a moderate effect.
Goadsby said:

It's important to note that participants knew they were getting treatment and a placebo was not used, although placebo-controlled trials have shown intravenous aspirin is effective in acute migraine. Our findings warrant more research into the use of IV aspirin for severe headache or migraine.

The authors inform that aspirin has the following potential side effects: vomiting, bleeding, exacerbations of asthma symptoms, kidney impairment, a rash, and nausea.

What is migraine?

A migraine is a severe, painful headache that is often preceded or accompanied by sensory warning signs such as flashes of light, blind spots, tingling in the arms and legs, nausea, vomiting, and increased sensitivity to light and sound. The excruciating pain that migraines bring can last for hours or even days.

Migraine headaches result from a combination of blood vessel enlargement and the release of chemicals from nerve fibers that coil around these blood vessels. During the headache, an artery enlarges that is located on the outside of the skull just under the skin of the temple (temporal artery). This causes a release of chemicals that cause inflammation, pain, and further enlargement of the artery.

A migraine headache can cause the sympathetic nervous system to respond with feelings of nausea, diarrhea, and vomiting. This response also delays the emptying of the stomach into the small intestine (affecting food absorption), decreases blood circulation (leading to cold hands and feet), and increases sensitivity to light and sound.

More than 28 million Americans suffer from migraine headaches, and females are much more likely to get them than males.

Symptoms of migraine can occur a while before the headache, immediately before the headache, during the headache, and after the headache. Although not all migraines are the same, typical symptoms include:

  • Moderate to severe pain, usually confined to one side of the head, but switching in successive migraines
  • Pulsing and throbbing head pain
  • Increasing pain during physical activity
  • Inability to perform regular activities due to pain
  • Nausea
  • Vomiting
  • Increased sensitivity to light and sound
Many people experience migraines with auras just before or during the head pain, but most do not. Auras are perceptual disturbances such as confusing thoughts or experiences and the perception of strange lights, sparkling or flashing lights, lines in the visual field, blind spots, pins and needles in an arm or leg, or unpleasant smells.

Click here to read about migraines in more detail.

Click here to read about headaches.

Click here to read about cluster headaches.

"Intravenous aspirin (lysine acetylsalicylate) in the inpatient management of headache"

M.W. Weatherall, PhD, FRCPEd, A.J. Telzerow, MD, E. Cittadini, MD, PhD, H. Kaube, MD and P.J. Goadsby, MD, DSc FRACP

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