A recent review posted in PubMed suggests that one dose of aspirin provides comparable pain relief to Imitrex.
This article originally appeared online at Dr.Pullen.com.
Really, I’m being serious here. A literature review posted at Pub Med suggests that a single dose of 900-1000 mg of aspirin gives pain relief comparable to Imitrex 50 or 100 mg, the usual doses, at 2 hours. This Cochane review from Great Britain showed that about half of patients had a reduction to none or mild pain with migraine headache by using a fairly high single dose of aspirin 1000 mg of aspirin (in the USA realistically this means taking three 325 mg aspirin for 975 mg) at the onset of migraine headache. This compared with only about 30% of patients taking placebo having equivalent relief. Certainly the triptan class of medications, imitrex and others, have been great additions to our migraine headache treatment regimens, but a good thing to try first is plain old aspirin.
The review also suggests that if nausea is a big concern, adding a single dose of 10 mg of metoclopramide (brand name Reglan- a prescription needed for this) is helpful in preventing nausea and vomiting.
Aspirin alone, or in combination with metoclopramide, is a very inexpensive option compared to imitrex. A price check for 9 imitrex tablets using Epocrates price comparison lists $238.12 or $26.45 per dose. Generic metoclopramide lists at $14.99 for 30 pills or about $0.43 per pill. Obviously aspirin is very inexpensive. This is worth the savings for the half of patients for whom it works. We need to remember to ask our patients if they have tried aspirin before we automatically put them on more expensive prescription meds. To read the PubMed abstract, link here.
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Ed Pullen, MD, is a board-certified family physician practicing in Puyallup, WA. He blogs at DrPullen.com — A Medical Bog for the Informed Patient.