Paracetamol role in migraine downplayed
29 November 2002
Migraine patients have been advised by a leading neurologist to try aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) instead of paracetamol as first-line treatment.
The advice runs counter to Australian guidelines that recommend patients try soluble paracetamol or soluble aspirin first.
'It is still very common for doctors to suggest, and patients to use, paracetamol because patients believe aspirin does something terrible to their kidneys and paracetamol is 'safe', as it says on the ads,' said director of the migraine clinic at St Vincent's Hospital, Melbourne, Dr John Heywood.
'But paracetamol is much less effective in migraine.'
Australian guidelines on migraine therapy published this year in the updated Therapeutic Guidelines analgesic and neurology editions, to which Dr Heywood contributed, gave doctors a choice of recommending soluble aspirin or soluble paracetamol.
'There are studies showing paracetamol works but, anecdotally, it is not as good as aspirin and evidence is starting to show it is weaker than aspirin and anti-inflammatories.'
Taking migraine therapy with a cup of coffee could improve absorption and effectiveness, according to some data on caffeine and analgesics, he added.
'There is strong community feeling that caffeine is bad for you — based on withdrawal headaches from heavy consumption — but it is quite useful with acute medication (medication used to treat specific episodes of disease not the underlying condition), providing it is not overused.'
Dr Heywood was commenting following new US guidelines on medication management and prevention of migraine (Annals of Internal Medicine 2002; 137: 840-49).
The guidelines emphasised non-steroidal anti-inflammatory drugs (NSAIDs) as first-line therapy, with most consistent evidence for aspirin, ibuprofen and naproxen sodium.
Both sets of guidelines (US and Australian) suggest limiting acute therapy to 2 or 3 times a week to guard against medication overuse ('drug-induced') headache.
The guidelines also quote fair evidence for modest effectiveness of hormone therapy, feverfew, magnesium and riboflavin.
Last Reviewed: 02 December 2002
- 1. Medical Observer Weekly 29/11/02
