Preventing and Managing Headaches

Finding relief is of paramount importance to anyone experiencing a severe headache. OTC analgesics are used extensively by many patients to self-treat and manage headaches. However, selecting these products may be overwhelming for some consumers, particularly those who have preexisting medical conditions or take other medications. Many individuals elect to self- treat headaches with 1 of the plethora of OTC analgesics on the market, and estimates show that more than two-thirds of OTC analgesic use is to relieve headache pain.¹ According to The Handbook of Nonprescription Drugs, diagnosed migraines, sinus headaches, and tension headaches, also known as stress headaches (Table 1^1,4,5), are most often amenable to self-treatment with nonprescription analgesics.¹ OTC analgesics are useful for treating headaches and may be used as a monotherapy or in conjunction with nonpharmacological measures or prescription therapy when appropriate.

Pharmacists are ideally positioned to aid patients seeking guidance on the self-treatment of headaches, as well as evaluate patients to ascertain if self-treatment is appropriate. Patients should be encouraged to seek further medical care from their primary health care provider when warranted. Additionally, prior to making any recommendations, pharmacists should screen for possible contraindications, drug—drug interactions, and therapeutic duplications. Pharmacists also can identify pharmacological agents that may cause headaches as an adverse effect, as well as make clinical recommendations accordingly and encourage patients to discuss concerns with their primary health care provider.

Types of Headaches

In general, headaches are categorized as primary or secondary.^1-3 An estimated 90% of headaches are primary and not related to an underlying illness.^1-3 Examples include cluster, medication overuse (also known as rebound), migraine, and tension headaches.^1-3

A headache is classified as secondary when it is caused by another underlying medical condition, including cerebral hemorrhage, head trauma, hematomas, meningitis or other bacterial or viral infections, metabolic disorders, severe hypertension, sinusitis, stroke, substance abuse or withdrawal, and temporomandibular joint dysfunction.^1-3 Patients experiencing secondary headaches should always be referred to their primary health care provider for further medical evaluation and treatment.

Nonprescription Therapies

Available OTC analgesics for the treatment and management of headaches include acetaminophen, nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen, and salicylates such as aspirin, magnesium salicylate, and sodium salicylate (Table 2).^1,4 Several formulations are available as single-entity or combination products, including capsules, chewable tablets, effervescent tablets, enteric coated, extended or sustained-release forms, gel capsules, liquids, liquigels, powders, rapid-release gel capsules, suspensions, and tablets (Table 3). Some formulations are marketed specifically for migraines and sinus and tension headaches and may contain a combination of ingredients to provide pain relief. Patients should be advised to always read product labels carefully, especially when using multi-ingredient products, to avoid unnecessary drug use or therapeutic duplications.^1,4 Factors that may influence the choice of OTC analgesics include allergies, cost, dosage forms and dosing intervals, medical history, medication profile, patient preference, the presence of contraindicating or precautionary factors, and medical history.^1,4

Prior to recommending any nonprescription analgesics, pharmacists must screen for potential allergies, contraindications, and drug—drug interactions. During counseling, patients should be reminded about the proper use of analgesics, including recommended duration, and be advised to take the products with food or milk if gastrointestinal upset occurs. Patients also should be advised of potential adverse effects. Patients with preexisting medical conditions or those taking prescription medications should discuss the use of nonprescription analgesics with their primary health care provider to ascertain appropriateness.

Although most headaches can be managed easily and last just a few hours, patients should be encouraged to seek further medical attention if they do not obtain relief from using these products, they experience chronic headaches, or headaches increase in frequency or intensity.^1,4 Patients also should be reminded that excessive use may lead to rebound or medication overuse headaches.^1,4 During counseling, pharmacists can remind patients who experience headaches to incorporate various nonpharmacological measures to reduce or prevent headaches, such as getting enough sleep, exercising daily, managing stress, eating a balanced diet, practicing relaxation techniques, and stretching the neck (Tables 4 and 5).¹ Patients with migraines should be reminded to avoid known triggers when possible and may also benefit from the use of cold packs to the forehead or temple areas to reduce the associated pain (Table 6).^1,4

Yvette C. Terrie, BSPharm, RPh, is a clinical pharmacist and medical writer based in Haymarket, Virginia.

References

• Wilkinson JJ, Tromp K. Headache. In: Krinsky D, Ferreri SP, Hemstreet B, et al, eds. Handbook of Nonprescription Drugs. 19th ed. Washington, DC: American Pharmacists Association; 2017.
• Silbertstein SD, Kimmel S. Approach to the patient with a headache. Merck Manuals website. merckmanuals.com/professional/neurologic-disorders/headache/approach-to-the-patient-with- headache. Updated July 2016. Accessed January 27, 2018.
• Headache. John Hopkins Medicine website. hopkinsmedicine.org/healthlibrary/conditions/adult/nervous_system_disorders/headache_85,p00784/ . Accessed January 27, 2018.
• Dlugosz C. Headaches. In: Dlugosz CK, ed. The Practitioner’s Quick Reference to Nonprescription Drugs. 2nd ed. Washington, DC: American Pharmacists Association; 2012.
• Hutchinson S. Understanding migraine sinus headaches. American Migraine Foundation website. americanmigrainefoundation.org/living-with- migraines/types-of-headachemigraine/sinus- headaches/. Published May 27, 2016. Accessed January 28, 2018.