A Cochrane review [Abstract] 1 included 23 studies with a total of 8079 subjects. All studies enrolled adults with frequent episodic tension-type headache (TTH). Participants had moderate or severe pain at the start of treatment. For the International Headache Society preferred outcome of being pain free at 2 hours, the NNT for paracetamol 1000 mg compared with placebo was 22 (95% CI 15 to 40; 8 studies, n=5890), with no significant difference from placebo at one hour. The NNT was 10 (7.9 to 14) for pain-free or mild pain at 2 hours in 5 studies (n=5238). The use of rescue medication was lower with paracetamol 1000 mg than with placebo, with an NNTp to prevent an event of 7.8 (6.0 to 11) in 6 studies (n=1856). On limited data, the efficacy of paracetamol 500 mg to 650 mg was not superior to placebo, and paracetamol 1000 mg was not different from either ketoprofen 25 mg or ibuprofen 400 mg (low quality evidence).Adverse events were not different between paracetamol 1000 mg and placebo (RR 1.1, 0.94 to 1.3; 11 studies, n=5605). Studies reported no serious adverse events.
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