I briefly review the purposes of efficacy measures, which go far beyond supporting new drug development. I use vignettes to illustrate the importance of functional recovery during the migraine attack, and argue that headache relief provides this. Sustained headache relief (SHR) is therefore a very worthwhile outcome when the alternative is a day of debilitating pain. As a measure, SHR may not be ideal for new drug development but it is informative to individuals, health care providers and politicians, and serves cost-effectiveness analysis better than any other. Cochrane are absolutely right to use it in systematic reviews along with the IHS-recommended measures.
Keywords: Cochrane Collaboration; Migraine; acute treatment; clinical trials; efficacy measures.
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