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Three Part Question

In [a young adult with mild to moderate pain from tension headaches] does [kapake or cocodamol offer better analgesia] in terms of [onset and duration of pain relief]?

Clinical Scenario

A 27 year old female with a 2 day history of headache attends the A&E department. Clinical assessment of this patient comforms with a diagnosis of tension headaches. She was given Kapake for pain relief and discharged.

Search Strategy

Medline using OVID interface 1966-6/98.
(exp acetaminophen/ or paracetamol.ti, ab, sh.) AND (exp codeine/ or codeine.ti, ab, sh.) AND (exp tension headache/ or exp headache/ or headache.ti, ab, sh.)

Search Outcome

28 papers of which 1 Russian, 1 German, 19 not relevant and 6 not specific to the question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Friedman AP and DiSerio FJ 1987 USA	198 adults evaluated for Fioricet, acetaminophen with codeine and placebo.	PRCT multicentre	4 hrs assessment of pain relief, emotional tension and muscle contraction.	Active analgesics effective than placebo.	Different strength than used in UK. Not comparing the analgesics in question. Poor explanation of statistics.

Comment(s)

Regarding the proposed question there was no paper addressing the different strengths of codeine compound.

Clinical Bottom Line

Unable to make a comparison between kapake and cocodamol as to pain relief effectiveness.

References

1. Friedman AP, DiSerio FJ. Symptomatic treatment of chronically recurring tension headache: a placebo-controlled, multicenter investigation of Fioricet and acetaminophen with codeine. Clinical Therapeutics 1987;10(1):69-81.