Lampl Christian, Voelker M, Diener H C
Dept. of Neurology, Pain and Headache Center, Krankenhaus der Barmherzigen Schwestern, Seilerstätte 4, A-4010 Linz, Austria.
J Neurol. 2007 Jun;254(6):705-12. doi: 10.1007/s00415-007-0547-2. Epub 2007 Apr 10.
Migraine is often associated with health consequences including impaired quality of life, and the cost of treating migraine headaches places a significant financial burden on patients who suffer from migraines. Nonsteroidal anti-inflammatory drugs (NSAIDs) and triptans are commonly used for the treatment of acute migraine attacks. Aspirin is widely accepted as a treatment option for migraine pain relief and could provide an alternative not only for treatment of moderate migraine attacks, but also for severe migraine attacks. The efficacy and safety of 1,000 mg effervescent aspirin (eASA) was evaluated in comparison to 50 mg sumatriptan and placebo in an individual patient data meta-analysis of three randomized, placebo-controlled, single- dose migraine trials. Pain-relief at 2 h, pain-free at 2 h and sustained pain-free up to 24 h were calculated. For eASA, the response rates were 51.5 % (95 % CI: 46.6-56.5 %), 27.1 % (95 % CI: 22.6-31.4 %), and 23.5 % (95 % CI: 19.3-27.7 %). For sumatriptan, the response rates were 46.6 % (95% CI: 40.0-53.2 %), 29% (95 % CI: 23.0-34.9 %), and 22.2 % (95 % CI: 16.7-27.6 %). The corresponding rates for placebo were 33.9 % (95% CI: 29.1-38.6 %), 15.1 % (95 % CI: 11.5-18.7 %), and 14.6 % (95 % CI: 11.0-18.1 %). The treatment effect of eASA and sumatriptan were significantly different from placebo (p < 0.001), but differences between eASA and sumatriptan were not significant. The remission of accompanying symptoms and the subgroup analyses of patients with moderate or severe migraine pain at baseline revealed no significant differences between eASA and sumatriptan. Safety was evaluated based on the frequency of reported adverse events, and treatment with eASA was associated with lower incidence of adverse events than was with sumatriptan. This individual patient data meta-analysis provided evidence that eASA 1,000 mg is as effective as sumatriptan 50mg for the treatment of acute migraine attacks and has a better side effect profile. This is also true for patients with moderate as well as severe headache at baseline. Patients therefore should be advised to use eASA first for migraine attacks and use a triptan in case of no response.
偏头痛常伴有包括生活质量受损在内的健康后果，偏头痛性头痛的治疗费用给偏头痛患者带来了巨大的经济负担。非甾体抗炎药（NSAIDs）和曲坦类药物常用于治疗急性偏头痛发作。阿司匹林被广泛认为是缓解偏头痛疼痛的一种治疗选择，它不仅可以作为治疗中度偏头痛发作的替代药物，也可用于重度偏头痛发作。在一项对三项随机、安慰剂对照、单剂量偏头痛试验的个体患者数据荟萃分析中，将1000毫克泡腾阿司匹林（eASA）与50毫克舒马曲坦及安慰剂进行比较，评估了其疗效和安全性。计算了2小时时的疼痛缓解情况、2小时时的无痛情况以及长达24小时的持续无痛情况。对于eASA，缓解率分别为51.5%（95%置信区间：46.6 - 56.5%）、27.1%（95%置信区间：22.6 - 31.4%）和23.5%（95%置信区间：19.3 - 27.7%）。对于舒马曲坦，缓解率分别为46.6%（95%置信区间：40.0 - 53.2%）、29%（95%置信区间：23.0 - 34.9%）和22.2%（95%置信区间：16.7 - 27.6%）。安慰剂的相应缓解率分别为33.9%（95%置信区间：29.1 - 38.6%）、15.1%（95%置信区间：11.5 - 18.7%）和14.6%（95%置信区间：11.0 - 18.1%）。eASA和舒马曲坦的治疗效果与安慰剂相比有显著差异（p < 0.001），但eASA与舒马曲坦之间的差异不显著。对伴随症状的缓解情况以及基线时中度或重度偏头痛疼痛患者的亚组分析显示，eASA与舒马曲坦之间无显著差异。根据报告的不良事件发生频率评估安全性，与舒马曲坦相比，eASA治疗的不良事件发生率较低。这项个体患者数据荟萃分析提供了证据，表明1000毫克eASA在治疗急性偏头痛发作方面与50毫克舒马曲坦同样有效，且副作用更小。对于基线时患有中度和重度头痛的患者也是如此。因此，应建议患者偏头痛发作时首先使用eASA，无反应时再使用曲坦类药物。
