For several decades, older adults have been popping daily low-dose aspirin to ward off heart attack and stroke. Because migraineurs with aura are twice as likely to experience one of these vascular events, it’s logical to assume aspirin should be one of their prevention staples. Recent research, however, may prove otherwise.
Although aspirin is the cornerstone of cost-effective treatment for reducing the risk of heart attack in men and stroke in women, the vascular benefits of aspirin for people with migraine are unknown. In a study being conducted at Swedish Medical Center and The University of Washington in Seattle, researchers funded by the National Headache Foundation are investigating the effectiveness of aspirin on platelet function in women with migraine.
“Our short-term objective with this study is to determine the prevalence of aspirin resistance in women with migraine,” says Jill Jesurum, PhD, principal investigator of the study. “Our long-term objective is to contribute to the development of guidelines for heart attack and stroke prevention in migraine. There are currently no published guidelines on this.”
Because the U.S. Preventive Services Task Force recommends against the use of aspirin for the primary prevention of stroke in women less than age 55, specialized guidelines are necessary for migraineurs.
“Even cardiovascular specialists do not see the need of aspirin for prevention in women under 55,” says Cindy Fuller, PhD, the study’s director. “But most migraineurs are premenopausal, so how do you reduce the risk in this group?”
Aspirin is often used to stop blood platelets from forming clots, which can cause heart attack or stroke. Aspirin resistance means the drug isn’t able to adequately inhibit platelet function and prevent the formation of clots, increasing a person’s chance of a cardiovascular event.
Jesurum and her team are curious whether migraineurs are even more susceptible to aspirin resistance due to platelet irregularities associated with migraine and frequent use of nonsteroidal anti-inflammatory drugs, which interfere with aspirin’s effect. Although the mechanism is not understood, aspirin therapy for cardiovascular disease is four times more likely to be ineffective in women. Because the majority of migraineurs are women, it stands to reason that there may be a high incidence of aspirin resistance in the migraine population.
According to Jesurum, most medical providers do not test for aspirin resistance before prescribing the drug. They simply assume it is working as intended.
Jesurum says she is particularly concerned about the subsets of migraineurs who may have even higher risks for heart attack or stroke, such as those who experience migraine with aura and use tobacco or oral contraceptives, and those who have a patent foramen ovale, an incomplete closure of the upper heart chambers.
The team’s preliminary research, the Response to Aspirin in Migraine Study (RAM), evaluated 50 episodic migraineurs who took 325 mg of aspirin for 14 to 21 consecutive days and found that 8% of them had aspirin resistance. This is significantly higher than published reports that fewer than 1% of non-migraineurs and 3.2% of people with cardiovascular disease have aspirin resistance to 325 mg. All of the migraineurs who were found to have aspirin resistance in the RAM study were women.
To further refine their results, the researchers are enrolling for a new study, Aspirin Resistance in Women with Migraine (ARWM), at the University of Washington in Seattle. This study extends the initial research by using a larger sample size and administering only 81 mg of aspirin, which is the recommended dose for primary and secondary prevention of heart attack and stroke. The study is designed to compare the prevalence of aspirin resistance in women with episodic and chronic migraine to that of women without migraine. Secondary aims will include comparisons of aspirin resistance between episodic and chronic migraineurs and between migraineurs with and without aura.
Jesurum is seeking premenopausal women between the ages of 18 and 55 who have been diagnosed with episodic or chronic migraine to enroll in the study. Participants will be required to make three one-hour visits to the Seattle area within a one-month period and provide a blood sample (15 cc) at each of the visits.
If you are a migraineur who is interested in participating in this study, please contact research coordinator Elisa McGee at 206-598-9260 or [email protected]. If you are a medical provider or researcher and would like to know more about the study, contact Jill Jesurum, PhD, at [email protected].
Episodic vs. Chronic Migraine
For the purposes of this study, episodic and chronic migraine are defined as follows:
Episodic
•Participants must experience between two and 14 migraine days per month for three months prior to enrollment.
•Participants must have a diagnosis of episodic migraine for at least two years.
Chronic
•Participants must experience at least 15 or more headache days per month for three months prior to enrollment, and eight or more of those headaches must be migraine.
•Participantsmust have a diagnosis of chronic migraine for at least two years.
