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Taking aspirin 1000 mg or lower doses was
found to provide good pain relief in individuals with 2 to 14 tension‐type
headaches per month.
One out of five people suffer from tension-type headache
around the world. It is mainly divided as: infrequent episodic TTH (fewer than
one headache per month), frequent episodic TTH (two to 14 headache days per
month), and chronic TTH (15 headache days per month or more). For acute episodic TTH treatment, aspirin is
recommended as one of the number of analgesics. The efficacy and safety of
aspirin for acute treatment of episodic tension-type headache (TTH) in adults
compared with placebo or any active comparator has been investigated in this
study.
The Cochrane Central Register of Controlled Trials
(CENTRAL), MEDLINE, Embase, and the Oxford Pain Relief Database were explored
from initiation to September 2016 along with the reference lists of supporting published
studies and reviews. The unpublished studies were soughted by asking personal
contacts and exploring online clinical trial registers and manufacturers'
websites.
Randomised, double-blind, placebo-controlled studies
(parallel-group or cross-over) were inculcated using oral aspirin for
symptomatic relief of an acute episode of TTH. These studies considered
participants aged 18 years or over, and include at least 10 participants per
treatment arm.
The studies for inclusion and extracted data were
independently examined by two review authors. The risk ratio (RR) and number
required to treat for one additional beneficial outcome (NNT), one additional harmful outcome (NNH), or to prevent one event (NNTp) for
oral aspirin compared to placebo or an active intervention were noted for
different outcomes (specifically those advocated by the International Headache
Society (IHS)). GRADE was used to assess the evidence and a 'Summary of findings' table was made.
Five studies were considered comprising of adults with
frequent episodic TTH. A total of 1812 participants took medication, of which
767 were considered in comparisons of aspirin 1000 mg with placebo, and 405 in
comparisons of aspirin 500 mg or 650 mg with placebo. In this review, not all
supplemented the outcomes for the relevant data. Four studies were identified
via the IHS diagnostic criteria. Out of these four, one predated commonly
recognised criteria, but reported comparable characteristics and excluded
migraine. The headaches treated were of least moderate pain intensity.
None of the included studies were at low risk of bias
across all domains considered, while for most studies and
domains this was likely because of inadequate reporting rather than poor
techniques. Due to small size, one study was believed to be at high risk of
bias.
At
two hours, there was no data for aspirin at any dose for the IHS preferred
outcome of being pain free or for that matter being pain free at any other
time, and only one study supplemented data equivalent to having no or mild pain
at two hours (very low quality evidence). The application of rescue medication
was lower with aspirin 1000 mg than with placebo (2 studies, 397 participants);
14% of participants used rescue medication with aspirin 1000 mg as
distinguished from 31% with placebo (NNTp 6.0, 95% confidence interval (CI) 4.1
to 12) (low quality evidence).
At
the closure of the study, two studies delineated a Patient Global Evaluation
when the top two categories were merged for both studies to reveal the number
of participants who were 'satisfied' with the treatment. More satisfied
participants (55%) were evaluated for aspirin 1000 mg than did placebo (37%)
(NNT 5.7, 95% CI 3.7 to 12) (very low quality evidence). Between aspirin 1000
mg and placebo (RR 1.1, 95% CI 0.8 to 1.5), or aspirin 500 mg or 650 mg and
placebo (RR 1.3, 95% CI 0.8 to 2.0) (low quality evidence) revealed no
different adverse events. No serious
adverse events were reported in these studies.
Low
quality evidence was found using GRADE comparing aspirin doses between 500 mg
and 1000 mg with placebo. Due to small number small number of studies and
events and lack of reports regarding significant efficacy measures, the
evidence was degraded. At any experimental doses, there was insufficient data
to compare aspirin with any active comparator (paracetamol alone, paracetamol
plus codeine, peppermint oil, or metamizole).
It
was culminated that a single dose of aspirin between 500 mg and 1000 mg
provided some advantage in terms of less frequent use of rescue medication.
More patient satisfaction was observed with treatment compared with placebo in
adults with frequent episodic TTH who have an acute headache of moderate or
severe intensity. For the number of people undergoing adverse events, no
difference between a single dose of aspirin and placebo was observed. Limited
amount and quality of the evidence was available and it should be elucidated
with caution.
Cochrane Database Syst Rev.
Aspirin for acute treatment of episodic tension-type headache in adults
Sheena Derry et al.
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