Staying Ahead of Headache Management: Tips for Pharmacists on Patient Recommendations

What is a Headache?

Headaches are a very common condition that most people will experience many times throughout their lifetime. A headache is characterized as a pain in the head or face that is often described as a pressure that is throbbing, constant, sharp, or dull. Headaches can differ in presentation depending on the type of headache, the location, and the severity. For some, headaches can be very debilitating and an inconvenience to daily living activities.

Around 96% of people have experienced a headache at least once during their lifetime.¹ Headaches can affect anyone, including children and adults.^1,2 There are many types of headaches, such as migraine headaches, tension headaches, sinus headaches, and drug-induced headaches.¹ Tension headaches are the most common type of headache and are often managed with OTC medications. Additionally, many patients can treat their headaches at home with the right lifestyle modifications and medications.

Image credit: Artem Furman | stock.adobe.com

Pharmacists can play a vital role in educating patients about headaches and can help to limit their impact on the patient. In addition to patient education, pharmacists can also recommend the patient visit their provider to discuss treatment options as OTC products may not be effective for all patients.³

When a patient presents seeking advice from a pharmacist, pharmacists should first seek to understand the symptoms and the frequency of the patient’s headaches. The Characteristics of Headaches for Referral chart (below) provides a list of items to look for when determining whether a patient should be referred to seek additional medical attention. If a patient is determined to be eligible for self-treatment, pharmacists can recommend a variety of non-pharmacological and OTC treatments for patients.

When to Refer Patients to Seek Medical Attention

Although headaches are often self-managed and are rarely dangerous, if the headache is accompanied by other characteristics, advise the patient to seek medical attention. Some examples of these characteristics are:^1-4

Characteristics of Headaches for Referral

Non-Pharmacological Treatment of Headaches

Patients should attempt to treat their migraines first without using medication.Helping patients identify their individual triggers and educating them about the importance of avoiding them could reduce the frequency of headaches.¹

1. Avoiding triggers: Preventing headaches is key. If a patient understands triggers and is able to make lifestyle modifications to support avoiding triggers, quality of life can be improved.
2. Applying cold compresses to the forehead or temple areas⁵: Cold compresses can be purchased, or patients may opt to make one at home with ice. Counsel the patient to wrap the ice in a towel (or any other barrier) prior to use, as it should not be applied directly to the face. Headache caps are available for purchase. This is a cap that fits over the head and covers the eyes. Many of the caps can be stored in the refrigerator or can be heated for a warm compress. Headache caps may allow patients to receive comfort from either the heat or cold. Additionally, many of them apply soft pressure to the head which can aid in relief.
3. Staying hydrated: Encourage patients to reflect on their water intake and make an intentional effort to drink the recommended amount of water
4. Resting in a dark room Headaches can often be aggravated or even triggered by bright lights. Patients may find comfort in a dark room and avoiding looking at computer or cellular screens for a period of time.

There are certain lifestyle factors that are common triggers of headaches.It is important for patients to recognize what triggers their headaches in an efforts to prevent a headache from occurring. Common triggers include, but are not limited to:^1,2

Common Headache Triggers

OTC Treatment of Headaches

Patients often reach out to pharmacists to seek advice on how to select OTC products. The chart below summarizes many of the OTC products available while also indicating their place in therapy. As with any recommendation, pharmacists must ask if the patient is on any additional medications, has medication allergies, or has any other underlying conditions prior to making an OTC recommendation.

OTC Options for Headache Management

Special Populations

As a pharmacist assesses patients and considers recommendations, there are special populations that one should remain mindful of.6-8,10 Patients who are pregnant or breastfeeding have special considerations to ensure the safety of the fetus or child. Patients who are less than 18 years old or over the age of 65 years old may have dosing and other medication considerations to ensure optimal safety.

• Acetaminophen is safe during pregnancy but aspirin should be avoided due to risk of causing fetal harm.
• Acetaminophen is safe during breastfeeding but ibuprofen, naproxen, and aspirin should be avoided.
• For children less than 18 years of age, acetaminophen and ibuprofen are safe when appropriately dosed based on the child’s weight. Acetaminophen should be avoided in children younger than 2 years unless prescribed by a physician¹¹ and ibuprofen should be avoided in infants younger than 6 months unless prescribed.¹² Naproxen should be avoided in children younger than 12 and aspirin should be avoided in all children.
• In adults older than 65 years, acetaminophen is safe. Ibuprofen, naproxen, and aspirin should be avoided.

Conclusion

Headaches are a common condition that patients can experience at any age. Counseling patients on how to self-manage their headache pain is important and allows a sense of autonomy for each individual’s health management. Having general knowledge on headache management is essential for providing recommendations to patients and knowing when to refer them to their providers. Although this article aims to summarize key information regarding supporting patients with headaches, always be sure to reference drug information resources if unsure and refer patients when necessary.

References

1. Headaches. Cleveland Clinic. Reviewed August 29, 2022. Accessed November 6, 2023. https://my.clevelandclinic.org/health/diseases/9639-headaches

2. Ambizas EM, Ambizas AH. Nonprescription treatment options for migraine. US Pharm. 2016;41(1):31-34.

3. Acute therapy: Why not over-the-counter or other nonspecific options? American Migraine Foundation. July 30, 2016. Accessed November 6, 2023. https://americanmigrainefoundation.org/resource-library/acute-therapy-why-not-otc-options/

4. American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache. 2019:59(1):1-18. doi:10.1111/head.13456

5. Ullman S. Can wearable ice packs really relieve migraine attacks? Everyday Health. January 24, 2023. Accessed November 6, 2023. https://www.everydayhealth.com/migraine/can-headache-hats-really-relieve-migraine-attacks/

6. Ibuprofen. Prescribing information. BASF. Updated December 21, 2022. Accessed November 6, 2023. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=8ea0e303-3967-4d71-8255-ac42a841ce28

7. Naproxen. Prescribing information. Reddy’s Laboratories. Updated January 16, 2023. Accessed November 6, 2023. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=29fc5a16-49ed-41ca-a296-bee34d1d12f6

8. Acetaminophen. Prescribing information. Mallinckrodt Pharmaceuticals. Updated January 3, 2019. Accessed November 6, 2023. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9f7cca9d-4230-49d7-b805-a1fbc73e31c9

9. Acetaminophen, aspirin, and caffeine. Prescribing information. GSK. Updated March 28, 2023. Accessed November 6, 2023. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2c8df1c7-7864-48df-939c-d9ae22e0f52c

10. Aspirin. Prescribing information. Bayer. Updated June 15, 2021. Accessed November 6, 2023. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3f3fcba9-fdb9-46ce-a1dd-8271d2b3555c

11. Acetaminophen and children: Why dose matters. Mayo Clinic. June 30, 2022. Accessed November 6, 2023. https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/acetaminophen/art-20046721

12. Ibuprofen dosing table for fever and pain. Healthychildren.org. Updated August 31, 2023. Accessed November 6, 2023. https://www.healthychildren.org/English/safety-prevention/at-home/medication-safety/Pages/Ibuprofen-for-Fever-and-Pain.aspx