Everyone experiences occasional headaches, but some individuals are more susceptible to them.
Everyone experiences occasional headaches, but some individuals are more susceptible to them. Many individuals elect to self-treat headaches using OTC analgesics. In fact, it is estimated that more than two-thirds of OTC analgesics are used for headache pain relief.1 The types of headache that are most amenable to self-treatment with OTC analgesics include tension headaches (also known as stress headaches), diagnosed migraines, and sinus headaches.1
Selecting an appropriate analgesic may be an overwhelming experience for some consumers, especially those who have pre-existing medical conditions or are taking other medications. Pharmacists are in an ideal position to guide patients on the proper selection and use of analgesics and can encourage patients to seek further medical care if self-treatment is not appropriate. 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, can make clinical recommendations, and can encourage patients to see their primary health care provider.
Types of Headaches
Headaches are commonly categorized as primary or secondary.1-3 Primary account for an estimated 90% of headaches and are not related to an underlying illness.1-3 Examples include tension headaches, cluster headaches, migraines, and medication overuse headaches (also known as rebound headaches) (Table 11,4,5).1-3
Secondary headaches result from an underlying medical condition.1-3 Examples of conditions that may these headaches include sinusitis, severe hypertension, head trauma, hematomas, temporomandibular joint dysfunction, metabolic disorders, substance abuse or withdrawal, stroke, cerebral hemorrhage, and meningitis or other bacterial or viral infections.1-3 Patients experiencing secondary headaches should always be referred to their primary health care provider for medical evaluation and treatment.
OTC analgesics for treating and managing headaches include acetaminophen, nonsteroidal anti-inflammatory drugs (eg, ibuprofen, naproxen), and salicylates (eg, aspirin, magnesium salicylate, sodium salicylate) (Table 2).1,4 These products are available as single-entity or combination products (eg, tablets, capsules, gel capsules, liquid gels, enteric-coated tablets, extended- or sustained-release forms, liquids, suspensions, effervescent tablets, rapid-release gel capsules, powders, chewable tablets) (Tables 3 and 4). Formulations are also marketed for sinus headaches, tension headaches, and migraines, and contain different combinations of ingredients to provide pain relief. For example, some medications for sinus headaches may contain an analgesic and a decongestant. 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
Table 3. Combination Product OTC Analgesics for Headaches
Naproxen sodium and pseudoephedrine
Acetaminophen, aspirin, caffeine
Aluminum hydroxide, aspirin calcium Carbonate, magnesium hydroxide
Acetaminophen and caffeine
Aspirin and caffeine
Ibuprofen and pseudoephedrine
Naproxen and pseudoephedrine
Aspirin, caffeine, salicylamide
Table 4. Topical OTC Analgesics for Headaches
The Pharmacist’s Role
Prior to recommending any OTC analgesic, pharmacists should always screen patients for potential allergies, contraindications, and drug—drug interactions. Patients should be reminded about the proper use of analgesics, including duration of use; be advised to take these products with food or milk if gastrointestinal upset occurs (Tables 51,4 and 61,4); and be warned about potential adverse effects associated with the use of these products. Patients with pre-existing medical conditions or who take prescription medications should discuss the use of OTC analgesics with their primary health care provider to ascertain appropriateness.
Table 5. Patient Counseling Tips Regarding Headaches and OTC Analgesics
APAP = acetaminophen; ASA = aspirin; GI = gastrointestinal; NSAID = nonsteroidal anti-inflammatory drug.Adapted from references 1 and 4.
Although most mild headaches can be easily managed and only last a few hours, patients should be encouraged to seek further medical care if they do not obtain relief from using OTC analgesics, if they experience chronic headaches, or if their headaches increase in intensity or frequency.1,4 Patients should also be reminded that excessive use of these products may lead to rebound headaches or medication overuse headaches.1,4
Table 6. Exclusions for Self-Treatment of Headaches
Adapted from references 1 and 4.
Pharmacists should remind patients to incorporate various nonpharmacologic measures to reduce or prevent headaches, such as relaxation techniques, stretching exercises for the neck, getting enough sleep, maintaining a balanced diet, and incorporating stress management and exercise into their daily routine.1 Patients with migraines should be reminded to avoid known triggers, when possible, and to apply cold packs to the forehead or temples to reduce the pain associated with migraines.1,4
Ms. Terrie is a clinical pharmacist and medical writer based in Haymarket, Virginia.