Aspirin is First-Line Treatment for Migraine and Episodic Tension-Type Headache Regardless of Headache Intensity

Headache: The Journal of Head and Face Pain, 09/08/2011

In neither migraine nor episodic tension–type headache (ETTH) does pre–treatment headache intensity predict success or failure of aspirin. This is not an arguable basis for stratified care in migraine. In both disorders, aspirin is first–line treatment regardless of headache intensity.


  • With regard to the first assumption, authors developed a rhetorical argument that need for treatment is underpinned by expectation of benefit, not by illness severity.
  • To address the second, authors reviewed individual patient data from 6 clinical trials of aspirin 1000 mg in migraine (N = 2079; 1165 moderate headache, 914 severe) and one of aspirin 500 and 1000 mg in ETTH (N = 325; 180 moderate, 145 severe), relating outcome to pre–treatment headache intensity.


  • In migraine, for headache relief at 2 hours, a small (4.7%) and non–significant risk difference (RD) in therapeutic gain favored moderate pain; for pain freedom at 2 hours, therapeutic gains were almost identical (RD: –0.2%).
  • In ETTH, for headache relief at 2 hours, RDs for both aspirin 500 mg (–4.2%) and aspirin 1000 mg (–9.7%) favored severe pain, although neither significantly; for pain freedom at 2 hours, RDs (–14.2 and –3.6) again favored severe pain.

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