title: Efficacy and safety of acetaminophen, aspirin, and caffeine in alleviating migraine headache pain: three double-blind, randomized, placebo-controlled trials.
abstract: OBJECTIVE
  To assess the effectiveness of the nonprescription combination of acetaminophen, aspirin, and caffeine in alleviating migraine headache pain.
  
  
  METHODS
  Three double-blind, randomized, parallel-group, single-dose, placebo-controlled studies.
  
  
  METHODS
  Private practice, referral centers, and general community.
  
  
  METHODS
  Migraineurs with moderate or severe headache pain who met International Headache Society diagnostic criteria for migraine with aura or without aura. The most severely disabled segment of migraineurs, including those whose attacks usually required bed rest, or who vomited 20% or more of the time, were excluded. Of the 1357 enrolled patients, 1250 took study medication and 1220 were included in the efficacy-evaluable data set.
  
  
  METHODS
  Two tablets of the nonprescription combination of acetaminophen, aspirin, and caffeine or placebo taken orally as a single-dose treatment of 1 eligible acute migraine attack.
  
  
  METHODS
  Pain intensity difference from baseline; percentage of patients with pain reduced to mild or none.
  
  
  RESULTS
  Significantly greater reductions in migraine headache pain intensity 1 to 6 hours after dose were seen in patients taking the acetaminophen, aspirin, and caffeine combination than in those taking placebo in each of the 3 studies. Pain intensity was reduced to mild or none 2 hours after dose in 59.3% of the 602 drug-treated patients compared with 32.8% of the 618 placebo-treated patients (P< .001; 95% confidence interval [CI], 55%-63% for drug, 29%-37% for placebo); at 6 hours after dose, 79% vs 52%, respectively, had pain reduced to mild or none (P<.001; 95% CI, 75%-82% vs 48%-56%). In addition, by 6 hours after dose, 50.8% of the drug-treated patients were pain free compared with 23.5% of the placebo-treated patients (P<.001; 95% CI, 47%-55% for drug, 20%-27% for placebo). Other migraine headache characteristics, such as nausea, photophobia, phonophobia, and functional disability, were significantly improved 2 to 6 hours after treatment with the acetaminophen, aspirin, and caffeine combination compared with placebo (P< or =.01).
  
  
  CONCLUSIONS
  The nonprescription combination of acetaminophen, aspirin, and caffeine was highly effective for the treatment of migraine headache pain as well as for alleviating the nausea, photophobia, phonophobia, and functional disability associated with migraine attacks. This drug combination also has an excellent safety profile and is well tolerated.
authors.affiliation: Department of Neurology, Albert Einstein College of Medicine, Montefiore Headache Unit, Bronx, NY 10467, USA. rlipton@imrinc.com
authors.forename: R B
authors.initials: RB
authors.lastname: Lipton
authors.forename: W F
authors.initials: WF
authors.lastname: Stewart
authors.forename: R E
authors.initials: RE
authors.lastname: Ryan
authors.forename: J
authors.initials: J
authors.lastname: Saper
authors.forename: S
authors.initials: S
authors.lastname: Silberstein
authors.forename: F
authors.initials: F
authors.lastname: Sheftell
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D002110:Caffeine / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000175:diagnosis / Q000188:drug therapy*; D010147:Pain Measurement; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000082:Acetaminophen; D002110:Caffeine; D001241:Aspirin