阿醜

作者：Emma Hitt, PhD  
出處：WebMD醫學新聞

　　April 19, 2010 — 根據一項於4月14日線上發表於考柯藍系統性綜論資料庫的文獻回顧結果顯示，單一劑量1000-mg的Aspirin可以有效緩解一半以上使用這個藥物病患的偏頭痛，而加上10 mg的metoclopramide可能減少噁心。
　　
　　英國牛津John Radcliffe醫院Nuffield麻醉科的Varo Kirthi醫師與其同事們寫到，Aspirin加上Metoclopramide將會是這個族群急性偏頭痛發作的第一線用藥。
　　
　　研究者們搜尋考科藍CENTRAL、MEDLINE、EMBASE以及牛津疼痛緩解資料庫直到2010年3月10日的研究，總共有13篇相關研究，收納了4,222位受試者，這些受試者被隨機分派、以雙盲、安慰劑控制方式、或是接受活性藥物；評估使用Aspirin治療單一偏頭痛發作；且每個治療組至少收納10位受試者。除此之外，這些研究比較aspirin 900 mg或是1000 mg（單獨使用或是併用），以及metoclopramide 10 mg相較於安慰劑或其他活性比較藥物（例如sumatriptan 50 mg或100 mg）。
　　
　　相較於安慰劑，Aspirin降低噁心、嘔吐、畏光與聲音恐懼症。單一1000-mg劑量的Aspirin在2小時內將疼痛從中重度降低到不痛的比例為24%，使用安慰劑的病患則是11%。52%使用Aspirin的受試者在2小時內嚴重或中等疼痛降低到輕度疼痛以下，相較於使用安慰劑的受試者則是32%。使用Aspirin受試者的2小時疼痛緩解持續至24小時的比例比服用安慰劑受試者高。
　　
　　除此之外，當Metoclopramide與Aspirin合併使用時，相較於僅使用Aspirin，顯著地減少噁心（P<0.00006）以及嘔吐（P=0.002），雖然這對於疼痛的效果影響不大。使用Aspirin受試者相較於使用安慰劑的受試者，需要緊急藥物治療的比例較低。相較於安慰劑，使用Aspirin的不良反應較常見，但是通常是輕微且短暫的。
　　
　　這項綜論也發現，僅使用Aspirin的效果與處方藥Sumatriptan 50 mg在2小時內疼痛緩解以及頭痛緩解的效果相當，然而，Sumatriptan 100 mg在2小時內疼痛完全消除的效果比Aspirin差，但是在頭痛緩解上並無差異；目前並沒有比較Sumatriptan與Aspirin用於24小時頭痛緩解的研究數據。
　　
　　研究作者R. Andrew Moore博士在一書面通知中寫到，Aspirin加上Metoclopramide將會是急性偏頭痛發作患者一個合理的治療選擇，但是對於大多數人，這可能不夠有效。他指出，我們現在正針對其他非處方用藥（OTC）用於治療偏頭痛的療效進行研究，以提供消費者用於治療且不需處方最佳的證據。


Single Dose of Aspirin Effective in Relieving Migraine Pain

By Emma Hitt, PhD
Medscape Medical News

April 19, 2010 — A single 1000-mg dose of aspirin is an effective treatment of acute migraine headaches for more than half of people who take it, and the addition of 10 mg of metoclopramide may reduce nausea, according to the findings of a literature review published online April 14 in the Cochrane Database of Systematic Reviews.

"Aspirin plus metoclopramide would seem to be a good first-line therapy for acute migraine attacks in this population," write Varo Kirthi, MD, and colleagues, with the Pain Research and the Nuffield Department of Anaesthetics at the John Radcliffe Hospital, in Oxford, United Kingdom.

The researchers searched Cochrane CENTRAL, MEDLINE, EMBASE, and the Oxford Pain Relief Database for studies through March 10, 2010. The 13 selected studies, including 4222 participants, were randomized, double-blind, placebo-controlled, or active-controlled; evaluated the use of aspirin to treat a single migraine headache episode; and included at least 10 participants per treatment group. In addition, studies compared aspirin 900 mg or 1000 mg (alone or in combination) and metoclopramide 10 mg vs placebo or other active comparators (typically sumatriptan 50 mg or 100 mg).

Compared with placebo, aspirin reduced associated symptoms of nausea, vomiting, photophobia, and phonophobia. A single 1000-mg dose of aspirin reduced pain from moderate or severe to no pain by 2 hours in 24% of people vs 11% taking placebo. Severe or moderate pain was reduced to no worse than mild pain by 2 hours in 52% taking aspirin vs 32% taking placebo. Headache relief at 2 hours was sustained for 24 hours more often with aspirin vs placebo.

In addition, metoclopramide, when combined with aspirin, significantly reduced nausea (P < .00006) and vomiting (P = .002) vs aspirin alone, although it had minimal effect on pain. Fewer participants taking aspirin needed rescue medication vs those taking placebo. Adverse events were reported more often with aspirin vs placebo but were mostly mild and transient.

The review also found that aspirin alone was comparable to the prescription medication sumatriptan 50 mg for 2-hour pain-free relief and headache relief, whereas sumatriptan 100 mg was superior to aspirin plus metoclopramide for 2-hour pain-free, but not headache, relief; no data comparing sumatriptan with aspirin for 24-hour headache relief were available.

"Aspirin plus metoclopramide will be a reasonable therapy for acute migraine attacks, but for many it will be insufficiently effective," noted study author R. Andrew Moore, DSc, in a written release. "We are presently working on reviews of other OTC [over-the-counter] medicines for migraines, to provide consumers with the best available evidence on treatments that don’t need a prescription," he said.

Cochrane Database Syst Rev. Posted online April 14, 2010.