Are you feeling frustrated? We wouldn’t blame you a bit. Just last week headlines around the world declared that otherwise healthy people should not take aspirin for heart attack prevention. But one renowned physician says his colleagues should consider recommending aspirin for migraines. If you feel as if you are riding the aspirin rollercoaster, join the club.
The Nay Sayers:
Last week we shared the latest review of aspirin against heart attacks. We summarized the findings of a large meta-analysis published in the (British Journal of Clinical Pharmacology, June 2, 2020) at this link. The bottom line from these investigators:
“Compared to other active medications, low‐dose aspirin had strong evidence for lower risk of bleeding, but also lower comparative efficacy. Low‐dose aspirin significantly lowers CVD [cardiovascular disease] risk and increases risk of bleeding.”
We find it amazing that even after 120 years aspirin continues to create controversy. We suspect that many health professionals find its over-the-counter status and low price a challenge. After all, aspirin remains one of the most affordable drugs in the pharmacy. How could it compare favorably with newer, fancier and far pricier prescription medicines?
One reader challenged the conclusion that aspirin is too dangerous for healthy people:
Morris shared this:
“I saw the article about how healthy people don’t need aspirin every day. When I had my heart attack the doc told me that the only reason I survived was because I had been taking an aspirin tablet daily for 40 years!”
Aspirin for Migraines?
On the one hand we are told that aspirin is good if you have had a heart attack. If you are healthy, however, it is not worth the risk. Now we want to share another perspective on aspirin for migraines.
This review of aspirin has to do with its use in the prevention of horrible headaches (American Journal of Medicine, April, 2020). One of the authors is Dr. Charles Hennekens. He is considered one of the world’s top scientists by his colleagues. He has contributed to three textbooks and over 750 medical publications. Dr. Hennekens held a prestigious endowed chair as Professor of Medicine at Harvard Medical School.
Dr. Hennekens and his co-authors reviewed data over the last several decades regarding aspirin for migraines. They concluded:
“The totality of evidence, which includes data from randomized trials, suggests that high-dose aspirin, in doses from 900 to 1300 mg, given at the onset of symptoms, is an effective and safe treatment option for acute migraine headaches. In addition, the totality of evidence, including, some but not all, randomized trials, suggests the possibility that daily aspirin in doses from 81 to 325 mg, may be an effective and safe treatment option for the prevention of recurrent migraine headaches.
“The relatively favorable side effect profile of aspirin and extremely low cost compared with other prescription drug therapies may provide additional clinical options for primary healthcare providers in the treatment of both acute and recurrent migraine headaches.”
Aspirin for Migraines vs. Risks:
Of course, no one should take high doses of aspirin without medical supervision. The same holds true for long-term use. Aspirin can cause stomach irritation and ulcers. And there is always a concern about bleeding.
New migraine medicines such as erenumab (Aimovig), fremanezumab (Ajovy) and galcanezumab (Emgality) could cost between $600 and $700 for a once-monthly injection. Health insurance may not always cover these new treatments. Bayer aspirin costs about 3 cents per pill.
Aspirin vs. Pre-Eclampsia:
What else can aspirin do? Surprisingly, many obstetricians now recommend aspirin for high-risk pregnancies (U.S. Preventive Services Task Force, Sept. 9, 2014). Low-dose aspirin, prescribed by a physician, may lower the risk of a serious condition called pre-eclampsia (Cochrane Database of Systematic Reviews, Oct. 30, 2019).
Aspirin vs. Cancer:
Most intriguing of all, aspirin continues to generate excitement with its anti-cancer activity. Scientists at Roswell Park Comprehensive Cancer Center have reported that patients taking low-dose aspirin have better survival statistics against head and neck cancer as well as non-small-cell lung cancer.
There is also evidence to suggest that regular aspirin use reduces the risk of colorectal and other digestive tract cancers (Annals of Oncology, May, 2020). Aspirin may also provide some protection against breast and prostate cancer.
The People’s Pharmacy Perspective on Aspirin for Migraines
Aspirin must be treated with respect because of the potential for serious adverse reactions. That is why a health professional should always monitor treatment and help weigh benefits and risks with this old OTC medication.
That said, we do believe that aspirin has some unique characteristics. As. Dr. Hennekens and his colleagues state, the extremely low cost of aspirin for migraines makes it desirable.
This would be especially true for people who a) do not have health insurance or b) who cannot get their insurance company to pay for the newer and pricier migraine shots.
The idea that aspirin may have anticancer activity is extraordinary. Researchers noted an association between aspirin and a lower risk of colorectal cancer over 30 years ago (Cancer Research, Aug. 1, 1988). There are now thousands of articles about this aspirin vs. cancer in the medical literature.
There are doubters, or course. For example, the people who wrote recently that healthy people should not take aspirin for their hearts added this:
Beyond CVD, low‐dose aspirin use has been linked to lower risk of cancers, overall mortality and other chronic conditions. The veracity of these claimed non‐cardiovascular effects is unclear. European and American guidelines currently do not support aspirin for cancer prevention, but the issue is unsettled.”
We cannot disagree, but we do find it astonishing that the anticancer potential remains unresolved after three decades. Even more fascinating is the fact that aspirin remains controversial after 120 years. Nevertheless, we tend to agree with Dr. Hennekens that aspirin deserves consideration for migraines as long as it is supervised by a health professional who can weigh the benefits against the risks.
Share your own thoughts about aspirin in the comment section below.