Pharmacists Can Offer Guidance on Medication Overuse for Patients With Headache Disorders, Migraines

Headache disorders are painful and debilitating and can cause substantial personal suffering and impair quality of life for patients, explained Sharon F. Clackum, PharmD, BCGP, CDM, FASCP, during a session at the American Society of Consultant Pharmacists (ASCP) 2022 Annual Meeting. Additionally, Clackum explained that there's a significant financial cost to patients with headache disorders as well, not only in the treatment of headaches, but also because of the time lost from work due to decreased productivity.

“The physical, emotional, and socioeconomic burdens of headaches are poorly acknowledged,” Clackum said. “There's not a lot of studies telling us exactly how much that financial burden is [for the patient with headache disorders].”

When determining the type of headache a patient has, Clackum noted that it is necessary to rule out common potential local causes, such as neck, sinus, or ear pain. Once these local causes are excluded, primary headache is the most likely diagnosis, Clackum explained.

Additionally, the most essential component in effective management of headache disorders is becoming aware of the underlying problem, what triggers the headaches, and then understanding the symptoms.

“It takes longer to recover without a correct diagnosis, and this sometimes is hard to do,” Clackum said. “If you don't have very differentiating symptoms, it's hard sometimes for the doctor to diagnose it, especially in primary care. They generally will send you to a headache specialist or neurologist.”

Additionally, Clackum noted it’s important to avoid the mismanagement of medications for headaches as well, because too much medicine can cause rebound headaches for patients.

“And this is where the pharmacist comes in, because you can use your medicine background to ensure rebound headaches don’t occur,” Clackum said. “If you understand how headaches work, then you can counsel patients to not take too much of a medication so that they can avoid rebound headaches.”

Also, Clackum explained that pharmacists can counsel patients to limit their use of OTC pain medications, and especially decongestants.

“People who have a lot of allergies in the spring and the fall tend to overuse decongestants, and then there will be rebound headaches from that,” Clackum said. “You want to restrict decongestant use to no more than 3 days per week to avoid the medication overuse headaches.”

Also, pharmacists can counsel patients on the importance of trying to limit caffeine intake to decrease the occurrence of headaches. Specifically, if patients shoot for 2 cups of coffee a day or 2 sodas a day, this should decrease the potential for headaches caused by over-caffeination.

“I know people that have had 6 cups of coffee by lunch,” Clackum said. “So if you have constant headaches, you need to limit that caffeine intake and any fluctuation in caffeine intake.”

Pharmacists can also advise patients with headache disorders against the use of any opioids for pain. Specifically, studies were conducted to assess the efficacy of opioids in addressing headache-related pain, and the data showed that opioids are not as effective as nonsteroidals.

“So we should try to educate against the use of [opioids for headache pain] as much as we can,” Clackum said.

Additionally, Clackum explained there's insufficient evidence demonstrating the efficacy of the use of SSRIs for the treatment of headache disorders as well. Clackum noted that more data would be valuable to assess the impact of commonly prescribed drugs on headache disorders, as there are a lack of data commensurate with the widespread nature of the occurrence of headaches in the general population.

“Migraines are the third most common disease in the world, and it's the leading cause of neurologic disability,” Clackum said. “I've seen patients that have literally missed 4 out of 5 days in a week [due to headache disorders].”

Reference

Clackum SF. Headaches: Tension, Sinus, Migraine … Oh My !! Presented at: American Society of Consultant Pharmacists (ASCP) 2022 Annual Meeting in San Antonio, TX; November 5, 2022.