Cochrane for Clinicians

Putting Evidence into Practice

Aspirin With or Without an Antiemetic for Acute Migraine Headaches in Adults

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Am Fam Physician. 2014 Feb 1;89(3):176-177.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See CME Quiz Questions.

Author disclosure: No relevant financial affiliations.

Clinical Question

Is aspirin, with or without an antiemetic, an effective therapy for acute migraine headache in adults?

Evidence-Based Answer

Aspirin, with or without an antiemetic, is an effective treatment for acute migraine headache. Adding the antiemetic metoclopramide (Reglan) significantly reduces migraine-related nausea and vomiting compared with aspirin alone. (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

Migraines are an exceedingly common and disabling affliction; 16.6% of U.S. adults report having migraines or severe headaches.1 Direct costs average $1,533 per person annually,2 whereas indirect costs are an estimated $12 billion each year.3 Most persons who have migraines do not take preventive medications, but nearly all treat acute attacks. Commonly used treatments include triptans, nonsteroidal anti-inflammatory drugs, acetaminophen, and caffeine. Aspirin and metoclopramide are inexp

The views expressed in this article are those of the authors and do not reflect the official policy or position of the U.S. government, Department of the Army, or Department of Defense.

The practice recommendations in this activity are available at


Kirthi V, Derry S, Moore RA. Aspirin with or without an antiemetic for acute migraine headaches in adults. Cochrane Database Syst Rev. 2013;(4):CD008041.


1. Schiller JS, Lucas JW, Ward BW, Peregoy JA. Summary health statistics for U.S. adults: National Health Interview Survey, 2010. Vital Health Stat. 10. 2012;(252):1–207.

2. Stokes M, Becker WJ, Lipton RB, et al. Cost of health care among patients with chronic and episodic migraine in Canada and the USA: results from the International Burden of Migraine Study (IBMS). Headache. 2011;51(7):1058–1077.

3. Hawkins K, Wang S, Rupnow MF. Indirect cost burden of migraine in the United States. J Occup Environ Med. 2007;49(4):368–374.

4. Colman I, Brown MD, Innes GD, Grafstein E, Roberts TE, Rowe BH. Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trials. BMJ. 2004;329(7479):1369–1373.

5. Headaches: diagnosis and management of headaches in young people and adults. NICE clinical guideline 150. London, United Kingdom: National Institute for Health and Care Excellence (NICE); 2012. Accessed August 4, 2013.

6. Beithon J, Gallenberg M, Johnson K, et al. Institute for Clinical Systems Improvement. Diagnosis and treatment of headache. 2013. Accessed August 4, 2013.

These are summaries of reviews from the Cochrane Library.

The series coordinator for AFP is Corey D. Fogleman, MD, Lancaster General Hospital Family Medicine Residency, Lancaster, Pa.

A collection of Cochrane for Clinicians published in AFP is available at

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