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Aspirin plus metoclopramide for acute migraine

Clinical bottom line:

Oral aspirin 900 mg plus metoclopramide 10 mg has been fully tested in three randomised trials with about 750 patients. The NNT for two hour headache response was 3.2 (2.6 to 4.0). The NNT for two hour pain free was 8.6 (6.2 to 14). There was no information for sustained outcomes.


Reference


AD Oldman, LA Smith, HJ McQuay, RA Moore. A systematic review of treatments for acute migraine. Pain 2002 97: 247-257.

Inclusion criteria were: treatment of acute migraine; randomised allocation to treatment groups; double-blind design; adult population and headache outcomes.

Search

Comprehensive searches of the following databases were made: MEDLINE (1966 - July 2000), EMBASE (1980 - June 2000), Cochrane Library (Issue 3, 2000) and the Oxford Pain Relief Database (1950 - 1994). A series of free text searches were undertaken, using generic and trade names. There was no restriction to language. Retrieved reports were searched for additional trials. Neither individual authors nor pharmaceutical companies were contacted for unpublished data.

Findings

Tables with all included trials and excluded trials are available. The three trials gave consistent results for two hour headache response (Figure 1). The main results are in Table 1.

Figure 1: Headache response at two hours


Table 1: Aspirin 900 mg plus metoclopramide 10 mg
  Number/total with outcome (%)
Outcome Number of trials Treatment Placebo NNT
(95%CI)
Two hour headache response 3 214/376
(57)
95/373
(25)
3.2 (2.6 to 4.0)
Two hour pain free 3 69/378
(18)
25/375
(7)
8.6 (6.2 to 14)
Headache response at 2 hours sustained to 24 hours no data

 

For oral aspirin 900 mg plus metoclopramide 10 mg, 214/376 patients (57%) had a headache response at two hours compared with 95/373 (25%) with placebo. The NNT was 3.2 (2.6 to 4.0). The NNT for two hour pain free was 8.6 (6.2 to 14).

Adverse effects

Adverse effects are not reported in any way that makes obvious sense.

Comment


Limited data from only three trials, but consistently showing efficacy for the easiest outcome, two hour headache response. Less effective at producing pain free patients at two hours, and no information on longer duration outcomes.