Scolaris Content Display Scolaris Content Display

Cochrane Database of Systematic Reviews

Aspirina para el tratamiento agudo de la cefalea tensional episódica en adultos

Information

DOI:
https://doi.org/10.1002/14651858.CD011888.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 13 January 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Pain, Palliative and Supportive Care Group

Copyright:
  1. Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Article metrics

Altmetric:

Cited by:

Cited 0 times via Crossref Cited-by Linking

Collapse

Authors

Contributions of authors

All authors have participated in the writing of the protocol and review.

Sources of support

Internal sources

  • The Oxford Pain Research Trust, UK.

    Institutional support

External sources

  • No sources of support supplied

Declarations of interest

SD: none known.

PW: none known.

RAM has received grant support from Grünenthal relating to individual patient level analyses of trial data regarding tapentadol in osteoarthritis and back pain (2015). He has received honoraria for attending boards with Menarini concerning methods of analgesic trial design (2014), with Novartis (2014) about the design of network meta‐analyses, and RB on understanding pharmacokinetics of drug uptake (2015). He has received honoraria from Omega Pharma (2016) and Futura Pharma (2016) for providing advice on trial and data analysis methods.

Acknowledgements

The Oxford Pain Research Trust provided institutional support for this protocol.

Cochrane Review Group funding acknowledgement: the National Institute for Health Research (NIHR) is the largest single funder of the Cochrane Pain, Palliative and Supportive Care Review Group. Disclaimer: the views and opinions expressed herein are those of the authors and do not necessarily reflect those of the NIHR, National Health Service (NHS), or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2017 Jan 13

Aspirin for acute treatment of episodic tension‐type headache in adults

Review

Sheena Derry, Philip J Wiffen, R Andrew Moore

https://doi.org/10.1002/14651858.CD011888.pub2

2015 Sep 25

Aspirin for acute treatment of episodic tension‐type headache in adults

Protocol

Guy Stephens, Sheena Derry, R Andrew Moore

https://doi.org/10.1002/14651858.CD011888

Differences between protocol and review

We have clarified our wording on IHS diagnostic criteria in the 'Description of the condition' section, and have included information on dosage of aspirin in the 'Description of the intervention' section.

In the protocol, we said that we would "look primarily for studies using aspirin alone, but also seek studies that used aspirin in combination with another active oral treatment". We have clarified this so that it now reads "We looked primarily for studies using aspirin alone, but also sought studies that compared a combination of aspirin and another active oral treatment with the non‐aspirin component alone".

We have changed the order in which secondary outcomes are reported. The new order is more logical, and is in line with the other reviews in this series. We have also added a post‐hoc analysis of Patient Global Evaluation of treatment as an exploratory analysis, in the absence of other data.

We have clarified our assessment of potential performance and assessment bias in the 'Methods' section. In this review, all outcomes were self‐assessed, so the same considerations apply to detection bias as performance bias.

In addition, we have modified Appendix 4 (GRADE) to align it more closely with the wording used in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011), and extended the description in the 'Methods' section of the GRADE assessment for exceptional circumstances to explain possible decisions.

Notes

A new search within two years is not likely to identify any potentially relevant studies likely to change the conclusions. Therefore, this review has now been stabilised until 2022 following discussion with the authors and editors. The review will be re‐assessed for updating in five years. If appropriate, we will update the review before this date if new evidence likely to change the conclusions is published, or if standards change substantially which necessitate major revisions.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Aspirin 1000 mg versus placebo, Outcome 1 Participants using rescue medication.
Figures and Tables -
Analysis 1.1

Comparison 1 Aspirin 1000 mg versus placebo, Outcome 1 Participants using rescue medication.

Comparison 1 Aspirin 1000 mg versus placebo, Outcome 2 Participant global evaluation: 'satisfied'.
Figures and Tables -
Analysis 1.2

Comparison 1 Aspirin 1000 mg versus placebo, Outcome 2 Participant global evaluation: 'satisfied'.

Comparison 1 Aspirin 1000 mg versus placebo, Outcome 3 Participants with any adverse event.
Figures and Tables -
Analysis 1.3

Comparison 1 Aspirin 1000 mg versus placebo, Outcome 3 Participants with any adverse event.

Comparison 2 Aspirin 500 mg or 650 mg versus placebo, Outcome 1 Participants with any adverse event.
Figures and Tables -
Analysis 2.1

Comparison 2 Aspirin 500 mg or 650 mg versus placebo, Outcome 1 Participants with any adverse event.

Summary of findings for the main comparison. Aspirin 1000 mg compared with placebo for episodic tension‐type headache

Aspirin 1000 mg compared with placebo for episodic tension‐type headache

Patient or population: adults with episodic tension‐type headache

Settings: community

Intervention: aspirin 1000 mg

Comparison: placebo

Outcomes

Outcome with
comparator

Outcome with
intervention

RR
(95% CI)

NNT, NNTp or NNH (95% CI)

No of studies, participants, events

Quality of the evidence
(GRADE)

Comments

Pain‐free at 2 hours

No data

No data

Very low

No data

Pain‐free at other time points (1, 4, 24 hours)

No data

No data

Very low

No data

Pain‐free or mild pain at 2 hours

61/112

78/103

Not calculated

1 study, 215 participants, 139 events

Very low

Downgraded three levels due to sparse data: single study with 215 participants in comparison

Use of rescue medication

310 in 1000

140 in 1000

RR 0.47 (0.31 to 0.70)

NNTp 6.0 (4.1 to 12)

2 studies, 397 participants, 91 events

Low

Downgraded two levels due to sparse data: small number of studies, participants and events

Patient Global Evaluation at end of study

370 in 1000

550 in 1000

RR 1.5 (1.2 to 1.8)

NNT 5.7 (3.7 to 12)

2 studies, 397 participants, 181 events

Very low

Downgraded three levels due to sparse data: small number of studies, participants, differences in scales and timing for the outcome, and post‐hoc nature of the analysis

Any adverse event

140 in 1000

160 in 1000

RR 1.1 (0.75 to 1.5)

NNH not calculated

3 studies, 723 participants, 107 events

Low

Downgraded two levels due to sparse data: small number of studies and events

Specific adverse events

Inconsistently reported and too few events for analysis

Included gastrointestinal upset or dyspepsia, nausea, dizziness, and somnolence

4 studies, 767 participants

Very low

Downgraded three levels due to sparse data: small number of studies, few events, inconsistent reporting

Serious adverse events

No events reported

No events reported

4 studies, 767 participants, no events

Very low

Downgraded three levels due to sparse data: small number of studies and no events

CI: confidence interval; NNH: number needed to treat for one additional harmful outcome; NNT: number needed to treat for one additional beneficial outcome; NNTp: number needed to treat to prevent one outcome; RR: risk ratio.

GRADE Working Group grades of evidence (EPOC 2015).

High: this research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different is low.

Moderate: this research provides a good indication of the likely effect. The likelihood that the effect will be substantially different is moderate.

Low: this research provides some indication of the likely effect. However, the likelihood that it will be substantially different is high.

Very low: this research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different is very high.

Substantially different: a large enough difference that it might affect a decision.

Figures and Tables -
Summary of findings for the main comparison. Aspirin 1000 mg compared with placebo for episodic tension‐type headache
Comparison 1. Aspirin 1000 mg versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Participants using rescue medication Show forest plot

2

397

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.31, 0.70]

2 Participant global evaluation: 'satisfied' Show forest plot

2

397

Risk Ratio (M‐H, Fixed, 95% CI)

1.47 [1.18, 1.83]

3 Participants with any adverse event Show forest plot

3

723

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.75, 1.53]

Figures and Tables -
Comparison 1. Aspirin 1000 mg versus placebo
Comparison 2. Aspirin 500 mg or 650 mg versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Participants with any adverse event Show forest plot

2

405

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.77, 2.02]

Figures and Tables -
Comparison 2. Aspirin 500 mg or 650 mg versus placebo