ACETYLSALICYLIC ACID IN THE PROPHYLAXIS OF MIGRAINE WITH AURA
Authors: Savi Lidia , Condello Cecilia , Bert Fabrizio , Pinessi Lorenzo 
Published: June 2024

Migraine with aura (MA) has a prevalence of about 1-5% and an incidence of 14.1‰ person-years, and can strongly affect lifestyle and quality of life. Although many known and effective prophylaxis drugs are now available for migrainous headache, none of these showed a particular specificity on the management of MA. While the use of Acetylsalicylic acid (ASA) in the acute management of migraine is well documented, evidences on its employment in prophylaxis of headache are few and contrasting; continuous use of ASA seems to affect the frequency of migraine episodes and higher week dosages could be consistently associated with better results. None of these studies stratified patients according to the presence of aura. Since many years, we started treating specifically patients with MA with low doses of ASA. Aim of our retrospective study was to assess the efficacy and the tolerability of ASA in the management of migraine with aura, and to identify potential predictors of positive outcome in prophylaxis of MA. We observed a cohort of MA patients and evaluated the average number of attacks per month of migraine with aura according to the headache diary. After the start of a prevention therapy (T0), outcome was evaluated at 2, 4 and 6 months (T1, T2 and T3, respectively) as percentage of the average number of attacks with aura reported in the first three months of observation. Only attacks with aura were considered for the evaluation. To evaluate improvement, we considered successful a treatment that induced a reduction of at least 50% in the number of attacks with aura at follow-up timelines compared to the baseline (T0). Report of side effects and treatment switch were recorded. In the end, 43 patients completed the 6 months of observation necessary for the evaluation of outcome of ASA therapy, and we tracked 33 that were treated with other therapies. Positive response to treatment was reported by 86.1% of patients in the ASA series and 41.9% in the other one (p< 0.001). Discontinuation of therapy at the end of the follow-up period was markedly higher in the group of patients treated with more classical courses of medication (18.6% vs 56.7%). We found that ASA is very effective in reducing the frequency of attacks with aura (p<0.001) and is well tolerated by patients (p<0.001). Moreover, our results show a better response to treatment with ASA compared with other therapies in the reduction of frequency of attacks with aura, with a probability of success that is difficult to evaluate seeing that we just observed two cases series, but apparently many times greater in the ASA group. Ideally the study should be replicated as a case-control study on a larger sample and a homogenous control group. In the end, we think that ASA can be safely used as an effective treatment in patients suffering from MA, or from a combination of MA and migraine without aura (MoA) if the attacks with aura are the most frequent migraine feature. Even though the number of patients with these characteristics is not very great, treatment with low-dose daily ASA could be interesting in this smaller group because of its being an extremely wieldy and inexpensive drug.