Acute pain and migraine: the evidence

Acute postoperative pain is a manifestation of inflammation due to tissue injury, and has been used as a model to determine analgesic efficacy for several decades. Migraine is a highly disabling condition for the individual and has wide-reaching implications for society, health care services, and the economy. We reviewed the evidence for 46 drug/dose combinations in postoperative pain to determine relative efficacy of different analgesics under standard conditions, and for several acute treatments for migraine, including over-the-counter treatments, triptans, and a combination of triptan and NSAID. We considered only studies reporting clinically relevant outcomes in clinical (not experimental) situations, and only studies with minimal risk of bias and sufficient events to avoid chance effects. The results show that many patients do not experience clinically useful levels of pain relief, even with the best treatments.