Intravenous Aspirin for Migraine Pain Relief?

When someone complains of having a migraine, they are referring to something far worse than the common headache.

The suggestion that aspirin might effectively treat migraine pain seems almost too good to be true, begging the question, "what's the catch?"

Aspirin, already widely used in Europe intravenously with good results, prompted researchers to review records of 168 hospitalized patients in London for chronic daily headaches and treated with an average of five doses of intravenous (IV) aspirin.  The study published this week in the American Academy of Neurology reported decrease in pain with the IV aspirin treatment.

Dr. Peter Goadsby, co-author of the study and director of the headache clinic at University of California, San Francisco said, "Aspirin pills are effective in treating acute forms of migraines. A more intense delivery of aspirin through IV injection may provide relief for a more intense type of headache."

Migraine is a neurological syndrome characterized by altered bodily perceptions, severe headaches, and nausea. Physiologically, the migraine headache is a neurological condition more common to women than to men.

The typical migraine headache affects one side of the head,  and pulsate between 4 - 72 hours including symptoms of  nausea, vomiting, increased sensitivity to light (photophobia), and increased sensitivity to sound (phonophobia).  About one-third of migraine sufferers perceive an aura, which is an unusual visual, olfactory, or other sensory experience indicating a migraine will soon occur.

About 20% of migraine patients take potentially addictive medications containing barbituates or opioids for migraine relief according to the National Headache Foundation.  Most migraine medications and treatments have a long list of side-effects and are sedating.  All medications work faster when injected as opposed to pill form, and the hope is that IV aspirin could relieve severe migraine pain.

"It [this study] also demonstrates that migraine patients are not looking for sedation or addiction, they're looking for relief," said Goadsby. "And if you can give them relief without all of the other side effects, then they'll be fine."

The International Headache Society  (IHS) offers guidelines for the classification and diagnosis of migraine headaches, in a document called "The International Classification of Headache Disorders, 2nd edition" (ICHD-2).

Migraines are a complex neurological event.  According to ICHD-2, there are seven subclasses of migraines (some of which include further subdivisions):

    * Migraine without aura, or common migraine, involves migraine headaches that are not accompanied by an aura (visual disturbance, see below).

    * Migraine with aura usually involves migraine headaches accompanied by an aura. Less commonly, an aura can occur without a headache, or with a non-migraine headache. Two other varieties are Familial hemiplegic migraine and Sporadic hemiplegic migraine, in which a patient has migraines with aura and with accompanying motor weakness. If a close relative has had the same condition, it is called "familial", otherwise it is called "sporadic". Another variety is basilar-type migraine, where a headache and aura are accompanied by difficulty speaking, vertigo, ringing in ears, or a number of other brainstem-related symptoms, but not motor weakness.

    * Childhood periodic syndromes that are commonly precursors of migraine include cyclical vomiting (occasional intense periods of vomiting), abdominal migraine (abdominal pain, usually accompanied by nausea), and benign paroxysmal vertigo of childhood (occasional attacks of vertigo).

    * Retinal migraine involves migraine headaches accompanied by visual disturbances or even blindness in one eye.

    * Complications of migraine describe migraine headaches and/or auras that are unusually long or unusually frequent, or associated with a seizure or brain lesion.

    * Probable migraine describes conditions that have some characteristics of migraines but where there is not enough evidence to diagnose it as a migraine with certainty.

Each patient's migraine experience is unique with varying signs and symptoms before, during and after the migraine occurs making it impossible to exactly define the migraine attack.

Four common phases which have been identified with migraine attacks are not experienced by all migraine sufferers, nor are any or all experienced during every migraine in the same person.
 
      1. The prodrome, which occurs hours or days before the headache in 40-60% of patients and consists of altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for a certain food, stiff neck muscles, hot ears, constipation or diarrhea and increased urination.

       2. The aura, which immediately precedes the headache in 20-30% of migraine sufferers is comprised of focal neurological phenomena that precede or accompany the attack.  Appearing gradually over 5-20 minutes and usually lasting fewer than 60 minutes when the pain phase usually begins. 

    The most common of the neurological events is the aura, a disturbance of vision usually consisting of flashes of white and/or black, or rarely multicolored lights or formations of dazzling zigzag lines or other arrangements.  Blurred, shimmering or cloudy vision and tunnel vision occur in some patients.

    The somatosensory consists of a pins and needles feeling in the hand and arm a well as in the nose/mouth area on the same side as the migraine.  The paresthesia can migrate up the arm extending to involve the face, lips and tongue.

    More symptoms of the aura phase include auditory, gusttory or olfactory hallucinations, vertigo, tingling or numbness of the face and extremities and hypersensitivy to touch.

    3. The pain/headache phase, usually accompanied by nausea (90%), vomiting (33%), sensory hyperexcitability, photophobia, phonophobia, blurred vision, delirium, nasal stuffiness, diarrhea, polyuria and sweating.  Extremities usually feel cold and moist and there may be localized edema of the scalp or face and/or prominence of a vein or artery in the temple.

    The migraine headache pain is usually unilateral, throbbing and moderate to severe lasting from 4-72 hours.  Physical activity often increases the level of pain as well as the length of the attack, however migraines are extremely variable in symptoms, intensity of pain, endurance of attacks and frequency of attacks.  The average migraine sufferer experiences 1-3 migraines per month.

       4. The postdrome phase of migraines leaves the individual feeling tired or "hungover" with head pain, cognitive difficulties, gastrointestinal symptoms, mood changes and weakness.

    "The Migraine Attack - A Clinical Description", Chpt. 9 says, "Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise."

Migraine Triggers:

A migraine trigger is any factor that, on exposure or withdrawal, leads to the development of an acute migraine headache. Triggers may be categorized as behavioral, environmental, infectious, dietary, chemical, or hormonal. In the medical literature, these factors are known as 'precipitants.'

MedlinePlus Medical Encyclopedia offers the following list of migraine triggers: allergic reactions, bright lights, loud noises, certain odors or perfumes, physical or emotional stress, change in sleep patterns, skipping meals, alcohol, menstrual cycle fluctuations, birth control pills, hormone fluctuations, tension headaches, foods containing tyramine (red wine, aged cheese, smoked fish), MSG, nitrates (hot dogs, bacon), other foods # chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods, and long exposures to light from computer screen, video screens, and tv.

Migraine Cause:

The simplest theory when it comes to causation of migraines includes both vascular and neural influences; stress triggers changes in the brain which cause serotonin to be released, causing blood vessels to constrict and dilate creating chemicals, including substance P irritate nerves and blood vessels, causing neurogenic inflammation and pain

Reiterating, migraines are incredibly complex so the idea that intravenous aspirin could provide relief to thousands of migraine sufferers sounds almost too simple.  However, IV aspirin has not yet been approved by the US Food and Drug Administration.

"I would hesitate to promote this as a holy grail of migraine treatment. I think this opens avenues for ways that (the) FDA could [begin] looking into," said Dr. Chaim Colen, director of neurosurgical oncology at Beaumont Hospitals in Grosse Pointe, MI. "Aspirin is a relatively inexpensive drug, and it could be useful."