Aspirin best prophylaxis for migraine with aura.
LONDON--Aspirin proved to be the most effective of the various agents used for prophylaxis of migraine with aura in an Italian study, with 86% of aspirin-treated patients reporting at least a 50% reduction in frequency of attacks. "We found the probability of treatment success with acetylsalicylic acid at 300 mg once daily was about six times greater than with other prophylactic agents," Dr. Lidia T Savi reported.
Dr. Savi, a neurologist at the University of Turin (Italy), presented a retrospective analysis of .194 consecutive patients at the university's headache center who were placed on prophylactic therapy for migraine with aura. Ninety were on aspirin at 300 mg/day. The rest were on various widely used prophylactic medications, with propranolol and topiramate topping the list.
The primary end point was treatment success as defined at week 32 by at least a 50% reduction in the frequency of attacks of migraine with aura, compared with baseline. Eighty-six percent of patients on aspirin for prophylaxis met this end point; indeed, 41% of the aspirin-treated group also met the more rigorous standard of 'extremely improved' as defined by a 75% reduction in attack frequency. Fourteen percent of patients were rated unimproved.
In contrast, 46% of patients on prophylactic agents other than aspirin were unimproved. Only 17% were judged extremely improved and 37% were improved.
Aspirin prophylaxis at the 300- mg dose was, as expected, well tolerated. No one switched to another agent within 32 weeks due to side effects. Moreover, treatment success rates in the aspirin group were the same at 16 weeks as at 32 weeks, so evidence of response to prophylactic aspirin is evident in a relatively short time, Dr. Savi continued.
In a multivariate analysis adjusted for age, gender, disease duration, and other variables, only prophylactic aspirin was independently associated with a positive treatment response. Patients on prophylactic aspirin were an adjusted 6.3-fold more likely than were those on other drugs to have at least a 50% reduction in migraine with aura frequency.
The prevalence of migraine with aura in the general population is estimated at 1%-5%. Most affected patients find the aura more disturbing and disruptive than the subsequent head pain.
Prior studies comparing prophylactic agents for migraine with aura have typically reported aspirin to be only mildly effective. However, these studies often contained only small numbers of patients and muddied the waters by mixing together subjects who had migraine with aura and those who had migraine without aura, according to Dr. Savi.
A double-blind, placebo-controlled study with a larger patient sample will be needed to confirm the Italian findings. Prophylactic aspirin's mechanism of benefit in migraine with aura isn't known. The disorder has been linked to platelet dysfunction. Dr. Savi's hypothesis is that daily aspirin prevents migraine with aura by curbing formation of microemboli.
RELATED ARTICLE: VITALS
Major Finding: Daily aspirin at 300 mg enabled 86% of migraine patients with aura to have at least a 50% reduction in attack frequency.
Data Source: This was a retrospective single-center study of 194 patients with migraine and aura treated with various prophylactic agents.
Disclosures: This study was free of commercial sponsorship. Dr. Savi reported having no financial disclosures.
ARTICLES BY BRUCE JANCIN
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|Publication:||Internal Medicine News|
|Date:||Nov 15, 2012|
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