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BMJ 2017;356:j225 doi: 10.1136/bmj.

j225 (Published 2017 January 05) Page 1 of 1

Research News


Aspirin for frequent episodic tension-type headache

has limited evidence
Susan Mayor

Evidence of aspirin’s efficacy for relieving acute pain in people included gastrointestinal upset or dyspepsia, nausea, dizziness,
with frequent episodic tension-type headache is limited, a and somnolence, but no serious adverse events were reported
Cochrane review of randomised studies has found.1 in any of the studies.
Frequent episodic tension-type headache is very common, its “Aspirin 1000 mg may relieve headache pain, but the evidence
global prevalence of 21% making it the second most prevalent is very weak, with few studies and participants, and no data for
condition after dental caries. This type of headache is diagnosed analysis of our predefined efficacy outcomes,” said the
in people with at least 10 episodes of tension-type headache in reviewers, led by Sheena Derry, of the University of Oxford,
their lifetime who have two to 14 days with headache each UK. They added that no information was available about aspirin
month. Aspirin is one of several analgesics suggested for for people with occasional headache.
treatment. “Aspirin does not appear to be associated with more adverse
Researchers searched medical databases for randomised, double events than placebo when a single dose up to 1000 mg is taken,
blind studies of oral aspirin for symptomatic relief of acute but this cannot be extrapolated to more frequent use,” the authors
episodes of tension-type headache in people aged over 18. They concluded. They recommended more research into the effects
found five studies including 1812 adults who took medicine for of analgesics in headache, with more rigorous outcomes and
headaches of at least moderate intensity, including 767 in studies the assessment of headache type and frequency in study
comparing a dose of 1000 mg aspirin with placebo and 450 participants.
people in studies comparing doses of 500 mg or 650 mg aspirin
with placebo.
The review, reported in the Cochrane Database of Systematic
Reviews, found no data on the number of people who were free
from pain at two hours, which is the preferred outcome for
assessing headache treatments.
But use of rescue medicine was lower with aspirin: only one in
seven people (14%) taking 1000 mg aspirin needed additional
painkillers for the headache, compared with one in three (31%)
of those taking placebo (two studies; 397 participants). This
meant that the number needed to treat to prevent one person
needing further treatment after taking aspirin for headache
(NNTp) was 6.0 (95% confidence interval 4.1 to 12). However,
the reviewers warned that this was based on low quality
More of the study participants allocated to aspirin 1000 mg were 1 Derry S, Wiffen PJ, Moore RA. Aspirin for acute treatment of episodic tension-type
satisfied with their treatment than those given placebo (55% v headache in adults. Cochrane Database Syst Rev 2017;356:CD011888. doi:10.1002/
37%; NNT 5.7 (3.7 to 12.0)).
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Around one in six people (16%) reported having an adverse granted under a licence) please go to http://group.bmj.com/group/rights-licensing/
effect after taking one dose of aspirin 1000 mg, similar to the permissions
rate in those taking placebo (14%). Specific events reported

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