Acetylsalicylic Acid
Place InTherapy
The literature supports the use of acetylsalicylic acid (ASA) or aspirin for acute treatment of mild to moderate tension-type headaches (TTHs).
The available evidence consistently demonstrates that ASA, dosed at 500 to 1000 mg at the onset of a TTH, is more effective than placebo at reducing pain intensity.1-3 Efficacy of ASA in TTH appears to be dose related, as at least two double-blinded randomized clinical trials (RCT) have demonstrated superior response rates with ASA 1000 mg compared to 500 mg.1,2 Compared to acetaminophen, ASA appears to be equally or more effective. One randomized controlled trial showed that ASA 1000 mg was significantly better at reducing pain intensity at 2 hour after drug administration than both acetaminophen 1000 mg and 500 mg and was faster-acting with beneficial effects seen within 30 minutes.1 Relative to other non-steroidal anti-inflammatories (NSAIDs), ASA appears to have similar effectiveness as one systematic review determined that all NSAIDs have equivalent efficacy against episodic TTHs.4
Based on the available literature, both British5 and European6 guidelines recommend ASA as a reasonable alternative for acute treatment of moderate TTHs. ASA is an effective, readily available, and cost effective alternative for treating TTHs. However, due to its safety profile, ASA is generally is not preferred. The aforementioned systematic review also found that, compared to ibuprofen, ASA was associated with a higher incidence of gastrointestinal complaints (such as stomach upset, nausea and diarrhea) and greater central side effects (such as dizziness).4,7
Because of its more favorable adverse event profile, ibuprofen is usually preferred over ASA and other NSAIDs as the first-line agent for acute relief of TTH. With NSAID hypersensitivity or concomitant warfarin use, ASA must be avoided and acetaminophen should be considered.4
References
1. Steiner T, Lange R, Voelker M. Aspirin in episodic tension-type headache: placebo-controlled dose-ranging comparison with paracetamol. Cephalalgia 2003: 23(1): 59–66.
2. Von Graffenried B, Nuesch E. Non-migrainous headache for the evaluation of oral analgesics. Br J Clin Pharmacol 1980; 10:
225S–231S.
3. Martínez-Martín P, Raffaelli E Jr, Titus F, et al. Efficacy and safety of metamizol vs. acetylsalicylic acid in patients with moderate
episodic tension-type headache: a randomized, double-blind, placebo- and
active-controlled, multicentre study. Cephalalgia.
2001; 21(5): 604-10.
4. Verhagen AP, Damen L, Berger MY, et al. Is any one analgesic superior for episodic tension-type headache? J Fam Pract 2006(12);
55:1064–72.
5. MacGregor EA, Steiner TJ, Davies PTG. Guidelines for All Healthcare Professionals in the Diagnosis and Management of Migraine, Tension-Type, Cluster and Medication-Overuse Headache. British Association for the Study of Headache. 2010;3(1):1-53
6. Bendtsen L, Evers S, Linde M, et al. EFNS Guideline on the Treatment of Tension-Type Headache. Eur J Neol. 2010, 17(11): 1318–25.
7. Diamond S. Ibuprofen versus aspirin and placebo in the treatment of muscle contraction headache. Headache 1983;23(5):206–10.
The available evidence consistently demonstrates that ASA, dosed at 500 to 1000 mg at the onset of a TTH, is more effective than placebo at reducing pain intensity.1-3 Efficacy of ASA in TTH appears to be dose related, as at least two double-blinded randomized clinical trials (RCT) have demonstrated superior response rates with ASA 1000 mg compared to 500 mg.1,2 Compared to acetaminophen, ASA appears to be equally or more effective. One randomized controlled trial showed that ASA 1000 mg was significantly better at reducing pain intensity at 2 hour after drug administration than both acetaminophen 1000 mg and 500 mg and was faster-acting with beneficial effects seen within 30 minutes.1 Relative to other non-steroidal anti-inflammatories (NSAIDs), ASA appears to have similar effectiveness as one systematic review determined that all NSAIDs have equivalent efficacy against episodic TTHs.4
Based on the available literature, both British5 and European6 guidelines recommend ASA as a reasonable alternative for acute treatment of moderate TTHs. ASA is an effective, readily available, and cost effective alternative for treating TTHs. However, due to its safety profile, ASA is generally is not preferred. The aforementioned systematic review also found that, compared to ibuprofen, ASA was associated with a higher incidence of gastrointestinal complaints (such as stomach upset, nausea and diarrhea) and greater central side effects (such as dizziness).4,7
Because of its more favorable adverse event profile, ibuprofen is usually preferred over ASA and other NSAIDs as the first-line agent for acute relief of TTH. With NSAID hypersensitivity or concomitant warfarin use, ASA must be avoided and acetaminophen should be considered.4
References
1. Steiner T, Lange R, Voelker M. Aspirin in episodic tension-type headache: placebo-controlled dose-ranging comparison with paracetamol. Cephalalgia 2003: 23(1): 59–66.
2. Von Graffenried B, Nuesch E. Non-migrainous headache for the evaluation of oral analgesics. Br J Clin Pharmacol 1980; 10:
225S–231S.
3. Martínez-Martín P, Raffaelli E Jr, Titus F, et al. Efficacy and safety of metamizol vs. acetylsalicylic acid in patients with moderate
episodic tension-type headache: a randomized, double-blind, placebo- and
active-controlled, multicentre study. Cephalalgia.
2001; 21(5): 604-10.
4. Verhagen AP, Damen L, Berger MY, et al. Is any one analgesic superior for episodic tension-type headache? J Fam Pract 2006(12);
55:1064–72.
5. MacGregor EA, Steiner TJ, Davies PTG. Guidelines for All Healthcare Professionals in the Diagnosis and Management of Migraine, Tension-Type, Cluster and Medication-Overuse Headache. British Association for the Study of Headache. 2010;3(1):1-53
6. Bendtsen L, Evers S, Linde M, et al. EFNS Guideline on the Treatment of Tension-Type Headache. Eur J Neol. 2010, 17(11): 1318–25.
7. Diamond S. Ibuprofen versus aspirin and placebo in the treatment of muscle contraction headache. Headache 1983;23(5):206–10.