Platelet Antagonists in Migraine Prophylaxis A Clinical Trial Using Aspirin and Dipyridamole

Abstract

SYNOPSIS The platelet hyperaggregability of the migraine population has lead us to postulate that platelet antagonists might be effective in migraine prophylaxis. A double‐blind cross‐over study of aspirin, 325 mg BID, combined with dipyridamole, 25 mg TID, compared to placebo and pretreatment conditions was undertaken. Platelet aggregation studies were done during the three month active medication and placebo periods. In patients with platelet hyperaggregability significant improvement occurred in headache frequency, intensity, and limitation of activity with no change in headache duration. Regardless of platelet aggregability, the 25 patients comprising the total sample significantly improved as compared to placebo. Sixty‐eight percent of the patients tested reported subjective improvement while taking the active medication. No side effects related to the medication were reported and no patients, including those who withdrew from the study for other reasons, reported worsening of headache while on the active medication. Although the significance of platelet hyperaggregability in migraine patients, and the pharmacological effect of aspirin and dipyridamole on this, is unclear, these medications may have potential as a method of migraine prophylaxis.

Aspirin and the Elderly

“…There is now substantial evidence to support a prophylactic role for low dosages of aspirin in the prevention of migraine (Baldrati et al 1983;Buring et al 1990;Masel et al 1980;O'Neill & Mann 1978;Ryan & Ryan 1982). This effect is probably mediated at least in part by the anti platelet effects of aspirin described previously.…”

Dipyridamole: A Critical Evaluation

“…135 Results of other trials suggest that dipyridamole alone or in combination with aspirin has a beneficial effect for migraine prophylaxis; however, failure to use appropriate control groups and statistical evaluation diminishes their value. [136][137][138] PERIPHERAL CIRCULATION DISORDERS Platelets are involved early in the formation of thrombi in venous circulation, although fibrin is the major component.9 The efficacy of low-dose heparin to prevent postoperative deep vein thrombosis (DVT) has been demonstrated. 139 Since heparin at low concentrations may affect platelet function primarily, it has been postulated that anti platelet agents also may be useful to prevent DVT.…”

The effectiveness of aspirin for migraine prophylaxis: a systematic review

“…Benseñor et al 19 was the only study that described incapacitation as an outcome; after having restricted the analysis to women who fulfilled the modified IHS criteria for migraine, they reported that there was a significant improvement in incapacitation after 12 months (OR = 1.45; 95% CI = 1.04 -2.02). Masel et al 30 reported on an intervention combining dipyridamole and aspirin, while Bousser et al 25 combined dihydroergotamine with aspirin as an active prophylactic treatment. Each study reported different doses of aspirin, and both compared the outcomes with those of a placebo group.…”

“…28 Only one study 19 classified migraine according to the IHS criteria. 29 Other studies either used their own definition of migraine 30 or did not mention at all how migraine was defined. 17,21,24 Overall, the studies 100,000 men in one year".…”