Acetylsalicylic Acid
| Evidence Level: L3 | Predicted Indications: 10 |
Table of Contents
- Acetylsalicylic Acid
- Acetylsalicylic Acid: From Pain, Inflammation and Cardiovascular Prevention to Migraine with Brainstem Aura
Acetylsalicylic Acid: From Pain, Inflammation and Cardiovascular Prevention to Migraine with Brainstem Aura
One-Sentence Summary
Acetylsalicylic acid (aspirin) is an established drug for pain and inflammatory conditions (including rheumatoid arthritis, osteoarthritis and headache disorders) and for cardiovascular events such as myocardial infarction. The TxGNN model predicts it may be useful for migraine with brainstem aura. Support is limited: no registered clinical trials and 20 publications, mostly from general migraine and migraine-with-aura populations rather than this specific subtype.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Rheumatoid arthritis, migraine, myocardial infarction / coronary thrombosis, osteoarthritis, common cold, headache disorders (from the TxGNN knowledge graph, because the Singapore licence records contain no indication text) |
| Predicted New Indication | Migraine with brainstem aura |
| TxGNN Prediction Score | 99.94% |
| Evidence Level | L3 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 6 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available in the compiled data. Based on known pharmacology, aspirin inhibits cyclooxygenase (COX), which reduces prostaglandin-mediated pain and neurogenic inflammation. Its antiplatelet effect may also matter in aura subtypes linked to microembolism, for example through a patent foramen ovale.
Aspirin is already used in acute migraine treatment and has been studied for migraine prevention. Migraine with brainstem aura is a subtype of migraine with aura, so the prediction is a natural extension of the existing migraine use. The literature includes a retrospective study of low-dose aspirin for preventing migraine with aura and a systematic review of antithrombotic drugs in migraine prevention.
No studies target the brainstem aura subtype specifically. The evidence is extrapolated from general migraine and migraine-with-aura populations, which is why the evidence level stays at L3.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 10448545 | 1999 | Randomized double-blind trial | Cephalalgia | 278 patients with acute migraine received IV aspirin lysinate, subcutaneous sumatriptan or placebo (efficacy and safety comparison) |
| 1589237 | 1992 | Randomized crossover study | Pain | In migraine, tension-type headache and healthy subjects, tested whether aspirin modulates an antinociceptive brainstem reflex |
| 39989443 | 2025 | Systematic review | Headache | Reviews the available evidence on antithrombotic drugs as migraine preventive medication |
| 25729594 | 2014 | Retrospective cohort | Curr Health Sci J | Compared low-dose aspirin (95 patients) with other prophylactic therapies (108 patients) for migraine with aura prevention, assessing efficacy and tolerability |
| 19708964 | 2009 | Guideline | Eur J Neurol | Revised EFNS expert guideline on migraine drug treatment |
| 16796580 | 2006 | Guideline | Eur J Neurol | Original EFNS guideline on migraine drug treatment, covering migraine with and without aura |
| 9606899 | 1998 | Clinical study | Zh Nevrol Psikhiatr | Preventive aspirin (1000, 500 and 100 mg) in 105 patients with migraine without aura; discusses predictors and contraindications |
| 15265054 | 2004 | Experimental study | Cephalalgia | IV aspirin vs oral zolmitriptan: effects on trigeminal pain processing in 28 migraine patients and healthy subjects |
| 15891416 | 2005 | Review | Curr Opin Neurol | Relationship between patent foramen ovale, cryptogenic stroke and migraine |
| 26908949 | 2016 | RCT | Eur Heart J | PFO closure in medically refractory migraine with aura (PRIMA trial); it tests a procedure rather than aspirin |
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Manufacturer |
|---|---|---|---|
| SIN08891P | ASPIRIN CARDIO 100 TABLETS 100 mg | Enteric coated tablet | Bayer AG |
| SIN05373P | ASPIRIN (E.C.) TABLETS 100 mg | Enteric coated tablet | Beacons Pharmaceuticals Pte. Ltd. |
| SIN05362P | BAYER ASPIRIN TABLET 500 mg | Tablet | PT Bayer Indonesia / Bayer S.A. |
| SIN15647P | TRINOMIA HARD CAPSULES 100mg/20mg/2.5mg | Capsule | Ferrer Internacional S.A. |
| SIN15648P | TRINOMIA HARD CAPSULES 100mg/20mg/5mg | Capsule | Ferrer Internacional S.A. |
One further Trinomia strength (SIN15646P, 100mg/20mg/10mg) is also registered, for 6 valid licences in total. All 6 are oral products. The licence records contain no approved indication text.
Safety Considerations
- Drug Interactions: The data compiled for this report list 100 known interactions. Major-level examples include acalabrutinib, acetazolamide, ketorolac, ibuprofen, fondaparinux and trastuzumab emtansine. Moderate examples include abciximab, nifedipine, hydrocortisone, ethanol and alendronic acid. Many of the major interactions involve bleeding risk or other NSAIDs.
Please refer to the package insert for warnings and contraindications.
Conclusion and Next Steps
Decision: Hold
Rationale: Aspirin has a plausible mechanism and an established role in migraine, but the evidence for the brainstem aura subtype is indirect. It is extrapolated from general migraine and migraine-with-aura studies, and no clinical trials are registered. This is best treated as a research question rather than a candidate ready for action.
To proceed, the following is needed:
- Subtype-specific clinical evidence, such as a prospective or randomized study in migraine with aura that includes brainstem aura patients
- Detailed mechanism of action data
- Package insert warnings and contraindications from the HSA, to support safety screening
- A bleeding-risk and drug-interaction review for the likely migraine patient population
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.