Aspirin is as effective as Imitrex (sumatriptan) in the treatment of migraine headaches with fewer side effects, according to an authoritative Cochrane review published earlier this year.  The review examined 13 high-quality studies which involved 4,222 patients.  Having such a large number of patients in well-conducted studies makes the data highly reliable.  Some of the studies utilized 900 mg of aspirin and some 1,000 mg, some with and some without a nausea medicine, metoclopramide (Reglan).  Aspirin was compared to both Imitrex, 50 or 100 mg and placebo.   The authors concluded that “there are no major differences between aspirin with or without metoclopramide and sumatriptan 50 mg or 100 mg. Adverse events with short-term use are mostly mild and transient, occurring slightly more often with aspirin than placebo, and more often with sumatriptan 100 mg than with aspirin.”  In a previous post I mentioned the review of 16 studies of naproxen sodium (Aleve) for the treatment of migraines.  That review found that aspirin was more effective for the treatment of migraines than naproxen sodium (Aleve).  So far, aspirin seems to be the best drug for the initial treatment of migraine headaches.  However, there are many sufferers with severe migraines who do not respond to aspirin and there is a clear need for prescription drugs, such as Imitrex, although they do have a higher risk of side effects.  New migraine drugs are being developed with the goal of reducing the incidence of side effects, while improving their efficacy.  One of the new category of drugs being developed are CGRP antagonists, but they are at least 2 years away from becoming available.