Magazine article Clinical Psychiatry News

Migraine with Aura: Aspirin Called Best Prophylaxis

Magazine article Clinical Psychiatry News

Migraine with Aura: Aspirin Called Best Prophylaxis

Article excerpt

LONDON--Plain old aspirin proved far and away 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 at the congress.

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, very well tolerated, with nobody switching to another agent within 32 weeks because of side effects. Moreover, treatment success rates in the aspirin group were the same at 16 weeks as at 32 weeks, so patients and their physicians can expect to see evidence of response to prophylactic aspirin 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. …

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