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Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figuras y tablas -
Figure 1

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Forest plot of comparison: 1 Aspirin 900 mg or 1000 mg versus placebo, outcome: 1.1 Pain free at 2 hours.
Figuras y tablas -
Figure 2

Forest plot of comparison: 1 Aspirin 900 mg or 1000 mg versus placebo, outcome: 1.1 Pain free at 2 hours.

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L'Abbé plot showing pain‐free at 2 h response in individual studies. Each circle represents one study, with size on the inset scale.
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Figure 3

L'Abbé plot showing pain‐free at 2 h response in individual studies. Each circle represents one study, with size on the inset scale.

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Forest plot of comparison: 1 Aspirin 900 mg or 1000 mg versus placebo, outcome: 1.2 Headache relief at 2 hours.
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 Aspirin 900 mg or 1000 mg versus placebo, outcome: 1.2 Headache relief at 2 hours.

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L'Abbé plot showing headache response at 2 h in individual studies. Each circle represents one study, with size on the inset scale.
Figuras y tablas -
Figure 5

L'Abbé plot showing headache response at 2 h in individual studies. Each circle represents one study, with size on the inset scale.

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Response rates for aspirin 900 mg plus metoclopramide 10 mg in consecutive attacks, reported in five studies (from left:Tfelt‐Hansen 1995; Chabriat 1994; Thomson 1992; Le Jeunne 1998; Geraud 2002)
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Figure 6

Response rates for aspirin 900 mg plus metoclopramide 10 mg in consecutive attacks, reported in five studies (from left:Tfelt‐Hansen 1995; Chabriat 1994; Thomson 1992; Le Jeunne 1998; Geraud 2002)

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Forest plot of comparison: 5 Aspirin ± metoclopramide versus placebo, outcome: 5.2 Use of rescue medication.
Figuras y tablas -
Figure 7

Forest plot of comparison: 5 Aspirin ± metoclopramide versus placebo, outcome: 5.2 Use of rescue medication.

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Comparison 1 Aspirin 900 mg or 1000 mg versus placebo, Outcome 1 Pain free at 2 hours.
Figuras y tablas -
Analysis 1.1

Comparison 1 Aspirin 900 mg or 1000 mg versus placebo, Outcome 1 Pain free at 2 hours.

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Comparison 1 Aspirin 900 mg or 1000 mg versus placebo, Outcome 2 Headache relief at 2 hours.
Figuras y tablas -
Analysis 1.2

Comparison 1 Aspirin 900 mg or 1000 mg versus placebo, Outcome 2 Headache relief at 2 hours.

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Comparison 1 Aspirin 900 mg or 1000 mg versus placebo, Outcome 3 Headache relief at 1 hour.
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Analysis 1.3

Comparison 1 Aspirin 900 mg or 1000 mg versus placebo, Outcome 3 Headache relief at 1 hour.

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Comparison 1 Aspirin 900 mg or 1000 mg versus placebo, Outcome 4 24‐hour sustained headache relief.
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Analysis 1.4

Comparison 1 Aspirin 900 mg or 1000 mg versus placebo, Outcome 4 24‐hour sustained headache relief.

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Comparison 1 Aspirin 900 mg or 1000 mg versus placebo, Outcome 5 Pain free at 2 hours ‐ effect of formulation.
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Analysis 1.5

Comparison 1 Aspirin 900 mg or 1000 mg versus placebo, Outcome 5 Pain free at 2 hours ‐ effect of formulation.

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Comparison 1 Aspirin 900 mg or 1000 mg versus placebo, Outcome 6 Headache relief at 2 hours ‐ effect of formulation.
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Analysis 1.6

Comparison 1 Aspirin 900 mg or 1000 mg versus placebo, Outcome 6 Headache relief at 2 hours ‐ effect of formulation.

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Comparison 1 Aspirin 900 mg or 1000 mg versus placebo, Outcome 7 Relief of associated symptoms at 2 hours.
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Analysis 1.7

Comparison 1 Aspirin 900 mg or 1000 mg versus placebo, Outcome 7 Relief of associated symptoms at 2 hours.

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Comparison 2 Aspirin 900 mg plus metoclopramide 10 mg versus placebo, Outcome 1 Pain free at 2 hours.
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Analysis 2.1

Comparison 2 Aspirin 900 mg plus metoclopramide 10 mg versus placebo, Outcome 1 Pain free at 2 hours.

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Comparison 2 Aspirin 900 mg plus metoclopramide 10 mg versus placebo, Outcome 2 Headache relief at 2 hours.
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Analysis 2.2

Comparison 2 Aspirin 900 mg plus metoclopramide 10 mg versus placebo, Outcome 2 Headache relief at 2 hours.

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Comparison 2 Aspirin 900 mg plus metoclopramide 10 mg versus placebo, Outcome 3 24‐hour sustained headache relief.
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Analysis 2.3

Comparison 2 Aspirin 900 mg plus metoclopramide 10 mg versus placebo, Outcome 3 24‐hour sustained headache relief.

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Comparison 2 Aspirin 900 mg plus metoclopramide 10 mg versus placebo, Outcome 4 Relief of associated symptoms at 2 hours.
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Analysis 2.4

Comparison 2 Aspirin 900 mg plus metoclopramide 10 mg versus placebo, Outcome 4 Relief of associated symptoms at 2 hours.

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Comparison 3 Aspirin 900 mg or 1000 mg versus active comparator, Outcome 1 Pain free at 2 hours.
Figuras y tablas -
Analysis 3.1

Comparison 3 Aspirin 900 mg or 1000 mg versus active comparator, Outcome 1 Pain free at 2 hours.

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Comparison 3 Aspirin 900 mg or 1000 mg versus active comparator, Outcome 2 Headache relief at 2 hours.
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Analysis 3.2

Comparison 3 Aspirin 900 mg or 1000 mg versus active comparator, Outcome 2 Headache relief at 2 hours.

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Comparison 3 Aspirin 900 mg or 1000 mg versus active comparator, Outcome 3 Headache relief at 1 hour.
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Analysis 3.3

Comparison 3 Aspirin 900 mg or 1000 mg versus active comparator, Outcome 3 Headache relief at 1 hour.

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Comparison 3 Aspirin 900 mg or 1000 mg versus active comparator, Outcome 4 Relief of associated symptoms at 2 hours.
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Analysis 3.4

Comparison 3 Aspirin 900 mg or 1000 mg versus active comparator, Outcome 4 Relief of associated symptoms at 2 hours.

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Comparison 4 Aspirin 900 mg plus metoclopramide 10 mg versus active comparator, Outcome 1 Pain free at 2 hours.
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Analysis 4.1

Comparison 4 Aspirin 900 mg plus metoclopramide 10 mg versus active comparator, Outcome 1 Pain free at 2 hours.

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Comparison 4 Aspirin 900 mg plus metoclopramide 10 mg versus active comparator, Outcome 2 Headache relief at 2 hours.
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Analysis 4.2

Comparison 4 Aspirin 900 mg plus metoclopramide 10 mg versus active comparator, Outcome 2 Headache relief at 2 hours.

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Comparison 4 Aspirin 900 mg plus metoclopramide 10 mg versus active comparator, Outcome 3 Relief of associated symptoms at 2 hours.
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Analysis 4.3

Comparison 4 Aspirin 900 mg plus metoclopramide 10 mg versus active comparator, Outcome 3 Relief of associated symptoms at 2 hours.

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Comparison 5 Aspirin ± metoclopramide versus placebo, Outcome 1 Any adverse event within 24 hours.
Figuras y tablas -
Analysis 5.1

Comparison 5 Aspirin ± metoclopramide versus placebo, Outcome 1 Any adverse event within 24 hours.

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Comparison 5 Aspirin ± metoclopramide versus placebo, Outcome 2 Use of rescue medication.
Figuras y tablas -
Analysis 5.2

Comparison 5 Aspirin ± metoclopramide versus placebo, Outcome 2 Use of rescue medication.

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Comparison 6 Aspirin ± metoclopramide versus active comparator, Outcome 1 Any adverse event within 24 hours.
Figuras y tablas -
Analysis 6.1

Comparison 6 Aspirin ± metoclopramide versus active comparator, Outcome 1 Any adverse event within 24 hours.

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Comparison 6 Aspirin ± metoclopramide versus active comparator, Outcome 2 Use of rescue medication.
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Analysis 6.2

Comparison 6 Aspirin ± metoclopramide versus active comparator, Outcome 2 Use of rescue medication.

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Aspirin 900 mg or 1000 mg compared with placebo for migraine headache

Patient or population: migraine headache ‐ moderate or severe pain

Settings: community

Intervention: aspirin 900 mg or 1000 mg

Comparison: placebo

Outcomes

Probable outcome with
intervention

Probable outcome with
comparator

NNT or NNTH and/or
relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Pain‐free at 2 h

240 in 1000

110 in 1000

NNT 8.1 (6.4 to 11)

6 studies, 2027 participants

357 events

Moderate1

Standard tablet and soluble formulations

Headache relief at 2 h

520 in 1000

320 in 1000

NNT 4.9 (4.1 to 6.2)

6 studies, 2027 participants

848 events

Moderate1

Standard tablet and soluble formulations

Sustained pain‐free at 24 h

No data

 

 

 

 

 

Sustained headache relief at 24 h

390 in 1000

240 in 1000

NNT 6.6 (4.9 to 10)

3 studies, 1142 participants

361 events

Moderate1

Standard tablet and soluble formulations

At least one AE

120 in 1000

90 in 1000

NNH 34 (18 to 340)

5 studies, 1892 participants

206 events

Low

Standard tablet and soluble formulations

Serious AE

Insufficient data

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 ‐ Quality of evidence downgraded from high because of threat from potential publication bias with modest effect size and numbers of events

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Comparison 1. Aspirin 900 mg or 1000 mg versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain free at 2 hours Show forest plot

6

2027

Risk Ratio (M‐H, Fixed, 95% CI)

2.08 [1.70, 2.55]

2 Headache relief at 2 hours Show forest plot

6

2027

Risk Ratio (M‐H, Fixed, 95% CI)

1.64 [1.48, 1.83]

3 Headache relief at 1 hour Show forest plot

4

1288

Risk Ratio (M‐H, Fixed, 95% CI)

2.13 [1.72, 2.63]

4 24‐hour sustained headache relief Show forest plot

3

1142

Risk Ratio (M‐H, Fixed, 95% CI)

1.63 [1.37, 1.95]

5 Pain free at 2 hours ‐ effect of formulation Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Soluble

4

1230

Risk Ratio (M‐H, Fixed, 95% CI)

1.92 [1.51, 2.44]

5.2 Tablet

2

797

Risk Ratio (M‐H, Fixed, 95% CI)

2.47 [1.70, 3.58]

6 Headache relief at 2 hours ‐ effect of formulation Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 Soluble

4

1230

Risk Ratio (M‐H, Fixed, 95% CI)

1.65 [1.43, 1.89]

6.2 Tablet

2

797

Risk Ratio (M‐H, Fixed, 95% CI)

1.64 [1.38, 1.95]

7 Relief of associated symptoms at 2 hours Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Nausea

4

878

Risk Ratio (M‐H, Fixed, 95% CI)

1.26 [1.10, 1.44]

7.2 Vomiting

3

139

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.94, 1.34]

7.3 Photophobia

5

1274

Risk Ratio (M‐H, Fixed, 95% CI)

1.47 [1.29, 1.69]

7.4 Phonophobia

5

1217

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [1.27, 1.64]
Figuras y tablas -
Comparison 1. Aspirin 900 mg or 1000 mg versus placebo
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Comparison 2. Aspirin 900 mg plus metoclopramide 10 mg versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain free at 2 hours Show forest plot

2

519

Risk Ratio (M‐H, Fixed, 95% CI)

2.68 [1.59, 4.55]

2 Headache relief at 2 hours Show forest plot

3

765

Risk Ratio (M‐H, Fixed, 95% CI)

2.15 [1.78, 2.60]

3 24‐hour sustained headache relief Show forest plot

1

257

Risk Ratio (M‐H, Fixed, 95% CI)

2.18 [1.39, 3.41]

4 Relief of associated symptoms at 2 hours Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Nausea

2

417

Risk Ratio (M‐H, Fixed, 95% CI)

7.53 [4.20, 13.50]

4.2 Vomiting

2

59

Risk Ratio (M‐H, Fixed, 95% CI)

16.14 [2.30, 113.05]
Figuras y tablas -
Comparison 2. Aspirin 900 mg plus metoclopramide 10 mg versus placebo
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Comparison 3. Aspirin 900 mg or 1000 mg versus active comparator

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain free at 2 hours Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Sumatriptan 50 mg

2

726

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.65, 1.03]

2 Headache relief at 2 hours Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Sumatriptan 50 mg

2

726

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.84, 1.11]

3 Headache relief at 1 hour Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Sumatriptan 50 mg

2

726

Risk Ratio (M‐H, Fixed, 95% CI)

1.59 [1.26, 1.99]

4 Relief of associated symptoms at 2 hours Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Photophobia

2

575

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.81, 1.04]

4.2 Phonophobia

2

540

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.86, 1.11]
Figuras y tablas -
Comparison 3. Aspirin 900 mg or 1000 mg versus active comparator
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Comparison 4. Aspirin 900 mg plus metoclopramide 10 mg versus active comparator

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain free at 2 hours Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Sumatriptan 100 mg

2

528

Risk Ratio (M‐H, Fixed, 95% CI)

0.63 [0.45, 0.87]

2 Headache relief at 2 hours Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Sumartiptan 100 mg

2

523

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.79, 1.10]

3 Relief of associated symptoms at 2 hours Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Nausea

2

410

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.83, 1.46]

3.2 Vomiting

2

67

Risk Ratio (M‐H, Fixed, 95% CI)

10.59 [1.43, 78.64]
Figuras y tablas -
Comparison 4. Aspirin 900 mg plus metoclopramide 10 mg versus active comparator
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Comparison 5. Aspirin ± metoclopramide versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any adverse event within 24 hours Show forest plot

7

2458

Risk Ratio (M‐H, Fixed, 95% CI)

1.26 [1.02, 1.55]

1.1 Aspirin alone

5

1892

Risk Ratio (M‐H, Fixed, 95% CI)

1.30 [1.00, 1.68]

1.2 Aspirin + metoclopramide

2

566

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.82, 1.67]

2 Use of rescue medication Show forest plot

8

2922

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.63, 0.72]

2.1 Aspirin 100 mg alone

5

1881

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.61, 0.73]

2.2 Aspirin 900 mg + metoclopramide 10 mg

3

1041

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.62, 0.77]
Figuras y tablas -
Comparison 5. Aspirin ± metoclopramide versus placebo
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Comparison 6. Aspirin ± metoclopramide versus active comparator

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any adverse event within 24 hours Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Aspirin versus sumatriptan 50 mg

2

730

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.61, 1.18]

1.2 Aspirin+met versus sumatriptan 100 mg

2

617

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.52, 0.84]

2 Use of rescue medication Show forest plot

4

1340

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [1.01, 1.28]

2.1 Aspirin versus sumatriptan 50 mg

2

726

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.92, 1.29]

2.2 Aspirin+met versus sumatriptan 100 mg

2

614

Risk Ratio (M‐H, Fixed, 95% CI)

1.18 [1.01, 1.39]
Figuras y tablas -
Comparison 6. Aspirin ± metoclopramide versus active comparator
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