Educate Patients About Nonprescription Products for Self-Treatment of Headaches

Finding relief is a top priority for anyone experiencing a headache. Although most people occasionally experience headaches, some individuals are more prone to them due to a combination of factors, including genetics, stress, certain foods, irregular sleep patterns, environmental triggers, hormonal changes, and the use of certain medications and underlying medical conditions. The discomfort associated with headaches can significantly disrupt health-related quality of life, negatively impacting sleep and productivity.

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Statistics from the CDC indicate that in 2021, an estimated 4.3% of adults aged 18 years and older reported experiencing several headaches or migraines during a 3-month period, with the percentage among women (6.2%) higher than among men (2.2%) and more frequent in younger individuals.¹ Additionally, percentages were higher among women than men across all age groups, with 7.4% vs 2.5% in ages 18 through 44, 6.7% vs 2.4% in ages 45 through 64, and 3.1% vs 1.5% in those aged 65 years and older.¹ The lowest percentage of those meaningfully affected by headaches or migraines in the past 3 months was in the age group of 65 years and older.¹

Types of Headaches

The Handbook of Nonprescription Drugs notes that the types of headaches most frequently amenable to self-treatment with OTC analgesics include tension-type headaches (also known as stress headaches), diagnosed migraines, medication overuse headaches, and sinus headaches. The Table^2,3 differentiates the types of headaches amenable to self-treatment.

Many consumers choose to use OTC analgesics as first-line treatment for self-treatment and management of headaches. Due to their drug expertise, pharmacists are instrumental in promoting the safe and proper use of these medications. An estimated two-thirds of nonprescription analgesic use is for the treatment of headaches. Furthermore, 24% of consumers frequently overuse analgesics, whereas only 14.5% were ever directed by their primary health care provider to limit the use of treatment for acute headaches, thus highlighting the need to expand patient education initiatives.²

Selecting the appropriate product can be overwhelming, especially for those with comorbidities or who are taking other medications, but pharmacists are uniquely positioned to assist patients in the selection and proper use of nonprescription analgesics. They can also encourage patients to seek further medical evaluation and treatment when appropriate, especially for those with undiagnosed migraines, severe and/or recurring headache, or chronic comorbidities, and pediatric patients. Additionally, pharmacists can screen for possible contraindications, drug-drug interactions, and therapeutic duplications. By reviewing patients’ medication profiles, pharmacists can identify medications that may be causing headaches, make clinical recommendations when appropriate, and encourage patients to see their primary health care provider when warranted.

OTC MEDICATIONS FOR HEADACHES

Nonprescription products marketed for the treatment of headaches include analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs (eg, ibuprofen, naproxen), and salicylates (eg, aspirin, magnesium salicylate, sodium salicylate), which are available in a variety of dosage forms. Formulations are also marketed for sinus headaches, tension headaches, and migraines, and contain different combinations of ingredients to provide pain relief. During counseling, pharmacists should advise patients to read product labels carefully to avoid unnecessary drug use or therapeutic duplications, especially when using multi-ingredient products.

RECENT CLINICAL DATA

Study findings published in Frontiers in Nutrition used data from the National Health and Nutrition Examination Surveynfrom 1999 to 2004 to examine dietary vitamin C intake among adults with migraine to determine whether there was an association between migraine incidence and vitamin C consumption. Results revealed that higher dietary vitamin C intake correlated with a lower risk of severe headaches or migraines, and individuals with the highest vitamin C consumption had 22% lower odds of experiencing these headaches compared with those with the lowest intake.⁴

According to other study findings published in Neurology, a diagnosis of hypertension, specifically elevated diastolic blood pressure, was associated with a marginally higher probability of ever having a migraine among female participants. However, the study did not find an increased risk between cardiovascular risk factors and migraine.⁵

Conclusion

Although most headaches are easily managed, patients should seek medical help if self-treatment does not provide relief; if they experience chronic or severe headaches that disrupt sleep, productivity, and overall health; or if their headaches become more frequent or intense. Additionally, patients should be aware that the excessive use of analgesics can cause rebound headaches or medication overuse headaches.

As frontline health care providers, pharmacists can be a valuable resource to patients dealing with headaches in several ways, including providing an assessment of the patient’s symptoms; provision of education about the types of headaches, recommendations based on individual patient needs, and suggestions for other nonpharmacologic measures; and encouraging patients to maintain routine care with their primary care provider.

REFERENCES

1. QuickStats: percentage of adults aged ≥18 years who have been bothered a lot by headache or migraine in the past 3 months, by sex and age group — National Health Interview Survey, 2021. MMWR Morb Mortal Wkly Rep. 2023;72(22):611. doi:10.15585/mmwr.7222a6

2. Wilkinson JJ, Tromp K. Headache. In: Krinsky DL, Ferreri SP, Hemstreet BA, Hume AL, Rollins CJ, Tietze KJ, eds. Handbook of Nonprescription Drugs. 20th ed. American Pharmacists Association; 2020.

3. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi:10.1177/0333102417738202

4. Zheng Y, Jin J, Wei C, Huang C. Association of dietary vitamin C consumption with severe headache or migraine among adults: a cross-sectional study of NHANES 1999-2004. Front Nutr. 2024;11:1412031. doi:10.3389/fnut.2024.1412031

5. Al-Hassany L, Acarsoy C, Ikram MK, Bos D, MaassenVanDenBrink A. Sex-specific association of cardiovascular risk factors with migraine: the population-based Rotterdam study. Neurology. 2024;103(4):e209700. doi:10.1212/WNL.0000000000209700

6. Lateef TM, Dey D, Leroux A, et al. Association between electronic diary-rated sleep, mood, energy, and stress with incident headache in a community-based sample. Neurology. 2024;102(4):e208102. doi:10.1212/WNL.0000000000208102