Aspirin for migraine

What aspirin is used for

Aspirin is an NSAID. The non-prescription label opened for this page lists temporary relief of headache, muscle pain, toothache, menstrual pain, pain and fever of colds, and minor arthritis pain. It does not name migraine.

NICE CG150 lists aspirin as a single-medicine option for acute migraine. Aspirin is also an ingredient of Excedrin, which has a different limit. The dose comes from the label or a prescriber. The dose reviewed below may differ from a dose on a product you own.

Cochrane results at 2 hours

Kirthi 2013 reviewed 13 studies with 4,222 participants. A 2017 search found no new studies. The evidence was rated moderate quality because of possible publication bias.

Outcome at 2 hours	Aspirin	Placebo	Number needed to treat
Pain-free	24%	11%	8.1
Headache relief	52%	32%	4.9

Adding the antiemetic metoclopramide improved relief of nausea and vomiting but made little difference to pain. Adverse events were mostly mild and transient and slightly more common than with placebo. The data on serious adverse events were insufficient.

Reye’s syndrome and other warnings

Reye’s syndrome. The label says children and teenagers who have or are recovering from chicken pox or flu-like symptoms should not use this product, and calls Reye’s syndrome a rare but serious illness. NICE goes further for migraine: preparations containing aspirin should not be offered to under-16s.

The same label also states:

• Allergy. Aspirin can cause a severe allergic reaction, with hives, facial swelling, wheezing or shock. Do not use it with an allergy to aspirin or another pain reliever or fever reducer.
• Stomach bleeding. The risk is higher from age 60, with past ulcers or bleeding, with blood thinners, steroids or other NSAIDs, and with 3 or more alcoholic drinks a day.
• Ask a doctor first. With a history of stomach problems, high blood pressure, heart disease, liver cirrhosis, kidney disease or asthma, or when taking a diuretic.
• Other medicines. Ask a doctor or pharmacist first when taking prescription medicines for gout, diabetes or arthritis.
• Pregnancy. Ask a health professional before use. Avoid in the last 3 months of pregnancy unless a doctor directs it, because it may cause problems in the unborn child or complications during delivery.

Monthly limit

ICHD-3 lists acetylsalicylic acid under NSAID overuse, within non-opioid painkillers. The limit is 15 or more days a month for more than 3 months. Days with aspirin add to days with ibuprofen, naproxen or acetaminophen, and the medication days counter treats them that way.

In a headache diary

Mark each dose taken for headache. If you also take aspirin daily for another reason, record it separately, so a doctor can tell which doses were for migraine. Record the pain at 2 hours and any stomach symptoms that followed.