Migraines are usually unilateral in nature, with throbbing associated with them and an aura prior to onset, which alerts patients to the migraine.
CASE 1: MIGRAINES
BF is a 22-year-old woman who comes to your pharmacy looking for something to help with her pain. She claims she has a unilateral headache, which suddenly came on. This type of headache has happened previously, and she usually turns the lights off. She says she is taking acetaminophen 500 mg every 4 to 6 hours with this latest occurrence, but because it is not providing much relief, she is looking for something stronger. Her mom suffered from migraines and used to take a medication to prevent them. She says she does not know the name of the medication, but would like to purchase it. She has no medical conditions or drug allergies and takes a multivitamin daily. Upon questioning, she states these headaches occur around the time when she has a lot of exams. She currently is a student at the university and needs something to help stop the headaches so she can study. What recommendations do you have for BF?
It appears that BF is suffering from migraines. Migraines are usually unilateral in nature, with throbbing associated with them and an aura prior to onset, which alerts patients to the migraine. If BF has an aura, she can be educated to take her medications during this time to help prevent the migraine. If symptoms progress to a full-blown migraine, patients can suffer from nausea, muscle weakness, and light sensitivity. For patients, the goal is to relieve pain and prevent further onset. Since BF has not been formally diagnosed with migraines, it is important to refer her to a physician. Many of the treatment options for migraines are not available over the counter. Other reasons to refer patients include severe head pain, headaches that persist for 10 days, high fevers, a history of liver damage, and children younger than 8 years.
CASE 2: SUNBURN
MR is a 48-year-old woman who comes to the pharmacy asking for something to help with her sunburn. She is on vacation with her family, and they have been on the beach for several days. Yesterday, she felt a little warm on her back and thought she might have gotten sunburned. Today, the pain is worse— and with redness. She denies any blisters, just pain and redness. MR is not allergic to any medication and has no chronic conditions. Upon questioning, she states she loves the beach and typically spends 6 to 8 hours at a time in the sun. She denies using any sunscreen. She has never burned like this before but was out more than usual in the sun. What would you recommend to help with MR’s pain?
The best way to avoid sunburn is to avoid UVR. To help soothe her pain, MR can try to use aloe. She can also use acetaminophen 500 mg every 4 to 6 hours. Since she spends a lot of time in the sun, it is important to educate her on sunscreen use, as well. Sunscreens are available in a variety of forms, including lotions, creams, ointments, gels, and wax sticks. Everyone, especially children older than 6 months, should use a broad-spectrum sunscreen with an SPF of at least 15 to help prevent skin damage from both UV-A and UV-B rays. The SPF number represents the level of sunburn protection provided by the sunscreen; a higher number means more protection. Because sunscreens should not be used on babies younger than 6 months, we recommend the use of hats, clothing, and shading to protect small babies from the sun. It is also important to tell MR that UVA rays are most intense during the middle of the day, usually between 10 am and 4 pm, and can cause wrinkling, brown splotches, and leathery skin. The stronger UVB rays that cause skin cancer show up around noon. If possible, MR should avoiding being exposed to the sun during these times.
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Dr. Mansukhani is clinical assistant professor at the Ernest Mario School of Pharmacy, Rutgers University, and transitions of care clinical pharmacist at Morristown Medical Center, Morristown, New Jersey. Dr. Bridgeman is clinical associate professor at the Ernest Mario School of Pharmacy, Rutgers University, and internal medicine clinical pharmacist at Robert Wood Johnson University Hospital, New Brunswick, New Jersey.