Pharmacists Could Placate Headache Management Concerns

A new study posits that physicians are taking more costly and less effective measures to treat patients with headaches.

By examining data from 1999 to 2010, researchers at the Beth Israel Deaconess Medical Center found that clinicians increasingly offer computed tomography (CT) scans or magnetic resonance imaging (MRI) and referrals to other physicians as first-line approaches to treat headaches, rather than provide counseling to patients about their lifestyles.

Advanced imaging increased from 6.7% of visits in the early years of the study period to 13.9% in the final years. Referrals also increased from 6.9% to 13.2%.

The researchers were particularly concerned about the increases in CT scans and MRIs, considering the ongoing efforts to control health care costs by decreasing low-value services. The authors pointed to a study that found 62% of CT head/brain studies are inappropriate, according to evidence-based guidelines.

While advanced imaging increased, clinician counseling fell from 23.5% to 18.5%, according to the results published in the Journal of General Internal Medicine.

The use of opioids or barbiturates did not increase over the study period, which the study authors described as encouraging news. Furthermore, they found that preventive medication use increased from 8.5% in 1999 to 15.9% in 2010.

Using evidence-based guidelines, clinicians are encouraged to use more “conservative” treatments, such as counseling, stress reducers, and dietary changes when treating patients with headaches. More intense treatment should only be sought if red flags such as cancer, trauma, or HIV are observed.

Lead study author John N. Mafi, MD, told Pharmacy Times that pharmacists can serve patients with headaches in many ways, as well.

“Pharmacists can play an important role in educating patients about the potential harms of OTC remedies such as ibuprofen or acetaminophen, as these drugs can harm patients with kidney or liver disease, or patients who have a history of (gastrointestinal) bleeding, particularly (nonsteroidal anti-inflammatory drugs),” Dr. Mafi told Pharmacy Times.

Dr. Mafi also suggested that pharmacists could help counsel patients on lifestyle changes. For example, they might be able to help patients identify certain dietary triggers for headaches.

“Finally, pharmacists can educate patients on the harms of medication overtreatment, as many of the drugs that treat headache may actually worsen headache if they are overused,” Dr. Mafi told Pharmacy Times.