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Efficacy and Safety of Acetaminophen, Aspirin, and Caffeine in Alleviating Migraine Headache Pain
Three Double-blind, Randomized, Placebo-Controlled Trials
Richard B. Lipton, MD;
Walter F. Stewart, PhD, MPH;
Robert E. Ryan, Jr, MD;
Joel Saper, MD;
Stephen Silberstein, MD;
Fred Sheftell, MD
Arch Neurol. 1998;55:210-217.
Objective To assess the effectiveness of the nonprescription combination of acetaminophen, aspirin, and caffeine in alleviating migraine headache pain.
Design Three double-blind, randomized, parallel-group, single-dose, placebo-controlled studies.
Setting Private practice, referral centers, and general community.
Patients Migraineurs with moderate or severe headache pain who met International Headache Society diagnostic criteria for migraine with aura or without aura. The most severely disabled segment of migraineurs, including those whose attacks usually required bed rest, or who vomited 20% or more of the time, were excluded. Of the 1357 enrolled patients, 1250 took study medication and 1220 were included in the efficacy-evaluable data set.
Intervention Two tablets of the nonprescription combination of acetaminophen, aspirin, and caffeine or placebo taken orally as a single-dose treatment of 1 eligible acute migraine attack.
Main Outcome Measures Pain intensity difference from baseline; percentage of patients with pain reduced to mild or none.
Results Significantly greater reductions in migraine headache pain intensity 1 to 6 hours after dose were seen in patients taking the acetaminophen, aspirin, and caffeine combination than in those taking placebo in each of the 3 studies. Pain intensity was reduced to mild or none 2 hours after dose in 59.3% of the 602 drug-treated patients compared with 32.8% of the 618 placebo-treated patients (P<.001; 95% confidence interval [CI], 55%-63% for drug, 29%-37% for placebo); at 6 hours after dose, 79% vs 52%, respectively, had pain reduced to mild or none (P<.001; 95% CI, 75%-82% vs 48%-56%). In addition, by 6 hours after dose, 50.8% of the drug-treated patients were pain free compared with 23.5% of the placebo-treated patients (P<.001; 95% CI, 47%-55% for drug, 20%-27% for placebo). Other migraine headache characteristics, such as nausea, photophobia, phonophobia, and functional disability, were significantly improved 2 to 6 hours after treatment with the acetaminophen, aspirin, and caffeine combination compared with placebo (P .01).
Conclusions The nonprescription combination of acetaminophen, aspirin, and caffeine was highly effective for the treatment of migraine headache pain as well as for alleviating the nausea, photophobia, phonophobia, and functional disability associated with migraine attacks. This drug combination also has an excellent safety profile and is well tolerated.
From the Departments of Neurology, Epidemiology, and Social Medicine, Albert Einstein College of Medicine, Montefiore Headache Unit, Bronx, NY (Dr Lipton); Johns Hopkins School of Public Health, Baltimore, Md (Dr Stewart); Innovative Medical Research, Baltimore (Drs Lipton and Stewart); Department of Otolaryngology, St Louis University School of Medicine, St Louis, Mo (Dr Ryan); Michigan Headache Pain and Neurological Institute, Ann Arbor (Dr Saper); Comprehensive Headache Center, Philadelphia, Pa (Dr Silberstein); and New England Center for Headache, Stamford, Conn (Dr Sheftell).
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