Abstract
Introduction
The empirical use of oral acetylsalicylic acid (ASA) in the treatment of acute migraine attacks has led to the recommendation of ASA as a basic treatment of migraine. However, there are no controlled studies on the intravenous use of acetylsalicylic acid.
Methods
Forty patients with a 1- to 12-year history of migraine were included in this placebo-controlled trial. The sociodemographic data of patients receiving placebo or 500 mg ASA i.v. and migraine symptoms before treatment were identically distributed. Pain relief during attacks was documented by the Visual Analogue Scale (VAS) for 1 h at 5-min intervals. Furthermore, the change of concurrent non-pain symptoms was evaluated by self-rating (worse-unchanged-better-absent).
Results
The VAS showed a mean pain reduction of about 60% after 1 h versus placebo. Efficacy varied significantly between patients. We observed a small number of socalled non-responders as well as patients with complete pain relief. The most common concomitant symptoms were nausea, photophobia, vertigo, vomiting and sweating. During the time of observation these symptoms were significantly reduced compared to placebo. The study shows a maximum placebo effect of about 17% (mean value). Significant differences in pain ratings were measured 25–30 min after application (P=0.0008).
Conclusions
In this study i.v. ASA showed a significant reduction in pain intensity during migraine attacks. In addition, most concomitant non-pain symptoms were equally reduced. The onset of pain relief did not correspond with the inhibition of platelet aggregation (after 2–4 min) or with peak plasma concentrations of ASA (immediately after application) or salicylic acid (after 2–3 h). More efficacy studies with higher doses and longer periods of observation are necessary to optimize the treatment of migraine attacks with intravenous ASA. Studies including neurophysiological and vascular parameters are recommended to confirm the results of this study.
Zusammenfassung
In einer plazebokontrollierten Doppelblindstudie wurde die Wirksamkeit von 500 mg intravenös applizierter Acetylsalicylsäure (ASS) an 40 Patienten mit Migräne mit oder ohne Aura untersucht, deren soziodemographische und krankheitsbezogene Daten sich nicht wesentlich unterschieden. Die Reduktion der Schmerzintensität wurde in 5-min-Abständen auf einer visuellen Analogskala erfaßt. Nicht schmerzbezogene Symptome wurden durch eine Selbstbeurteilungsskala erhoben (schlechter-unverändert-besser-fehlend).
Bei Gabe von i.v. ASS (Aspisol®) zeigte sich gegenüber Plazebo nach 1 h durchschnittlich eine Schmerzreduktion um 60%. Der maximale Plazeboeffekt lag bei 17%. Auch die Begleitsymptomatik der Migräne wurde unter i.v. ASS signifikant gemildert. Signifikante Unterschiede zwischen Verum und Plazebo ergaben sich ab der 30. min (p=0,0008). Der Wirkungseintritt von i.v. ASS korreliert weder mit den maximalen Plasmaspiegeln von ASS oder Salicylsäure noch mit dem Beginn der Hemmung der Plättchenaggregation (nach ca. 2–4 min). Die Bedeutung dieser Daten für das Verständnis des Wirkungsprinzips der Acetylsalicylsäure bei der Therapie der Migräne sowie der Bedarf weiterer Studien zur Optimierung der Wirkung von ASS in der Behandlung der akuten Migräneattacke wird diskutiert.
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Taneri, Z., Petersen-Braun, M. Therapie des akuten Migräneanfalls mit intravenös applizierter Acetylsalicylsäure. Schmerz 9, 124–129 (1995). https://doi.org/10.1007/BF02530130
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DOI: https://doi.org/10.1007/BF02530130