{"id":627568,"date":"2024-04-11T09:30:49","date_gmt":"2024-04-11T13:30:49","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=627568"},"modified":"2024-10-25T10:01:13","modified_gmt":"2024-10-25T14:01:13","slug":"counseling-patients-with-chronic-headaches","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/counseling-patients-with-chronic-headaches\/","title":{"rendered":"Counseling patients with chronic headaches"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Everyone gets a headache from time to time. According to the World Health Organization (WHO), an estimated 50%&ndash;75% of adults have had at least one headache in the past year. However, some people get headaches more frequently. <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK559083\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Headaches are considered chronic<\/span><\/a><span style=\"font-weight: 400;\"> if you experience 15 or more headache episodes per month for at least three months. Chronic headaches affect <\/span><a href=\"https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/headache-disorders\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">1.7%&ndash;4%<\/span><\/a><span style=\"font-weight: 400;\"> of adults globally, also according to the WHO.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Many people with recurrent headaches rely on over-the-counter (OTC) medications. In the U.S. and U.K., only half of people with migraines have seen a healthcare provider for their headaches in the past year, and only two-thirds have been diagnosed correctly, per the WHO. However, OTC pain relievers may not be the best solution for chronic headaches&mdash;and overuse of these medications can make headaches worse.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">As a pharmacist, you have an opportunity to help people find relief or refer them to a healthcare provider when appropriate. Pharmacists can suggest non-pharmacological and over-the-counter treatments to patients deemed eligible for self-care. This article aims to help pharmacists refresh their knowledge to effectively counsel patients on how to manage chronic headaches.<\/span><\/p>\n<h2 id=\"types-of-headache\"><span style=\"font-weight: 400;\">Types of headache<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">When patients seek your advice on how to treat chronic headaches, ask about their symptoms and where their head hurts. Ask how often they experience headaches and what they think is causing them. Gathering this information may help determine the <\/span><a href=\"https:\/\/www.uptodate.com\/contents\/headache-causes-and-diagnosis-in-adults-beyond-the-basics\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">type of headache<\/span><\/a><span style=\"font-weight: 400;\">, which can guide your treatment or referral recommendations.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Headache disorders are either primary or secondary. Primary headache disorders have no other cause, while secondary headaches can be attributed to another condition or cause, and the headache is just a symptom. Regardless of whether they are primary or secondary, most headaches fall into one of three main categories: tension headache, migraine headache, or cluster headache.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Tension headaches<\/b><span style=\"font-weight: 400;\"> are often brought on by stress. Symptoms typically include pressure or tightness around both sides of the head. The pain is usually mild to moderate and steady. The pain and tightness can also affect the neck and shoulder muscles.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.uptodate.com\/contents\/migraines-in-adults-beyond-the-basics\" target=\"_blank\" rel=\"noopener\"><b>Migraine headaches<\/b><\/a> <span style=\"font-weight: 400;\">cause moderate to severe pain that usually only affects one side of the headache. The pain may be dull, throbbing, or pulsating. Other symptoms may occur, such as nausea, vomiting, blurred vision, and sensitivity to light or sound. Migraines are more common in females than males.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/35029932\/\" target=\"_blank\" rel=\"noopener\"><b>Cluster headaches<\/b><\/a><span style=\"font-weight: 400;\"> occur in &#8220;clusters,&#8221; with multiple headaches a day, followed by headache-free periods. The pain is sudden and severe, usually affecting one side of the head. Other symptoms may include watery eyes, runny nose, eyelid drooping or swelling, and restlessness. Cluster headaches are more common in males.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Some people develop chronic headaches, which are not specific types of headache disorders but rather describe the frequency or, in some contexts, the duration. Chronic headache refers to headaches occurring on more than 15 days each month for at least three months. Chronic headaches are usually tension-type or migraines. For some people, these headaches occur daily and may last for hours.<\/span><\/p>\n<h2 id=\"medication-related-headaches\"><span style=\"font-weight: 400;\">Medication-related headaches<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">As pharmacists, you can help patients and caregivers determine medication-related causes of chronic headaches. By identifying factors causing or contributing to headaches, patients can take steps to manage them better or avoid them.&nbsp;<\/span><\/p>\n<h3 id=\"headache-inducing-medications\"><span style=\"font-weight: 400;\">Headache-inducing medications<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">As patients seek your advice for headaches, use the opportunity to update their medication list and check their profile for potential causes. Many prescription drugs cause headaches as a common side effect.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">When reviewing the potential side effects of prescription medications, &ldquo;headache&rdquo; often tops the list. However, certain classes of drugs may be more likely to cause headaches than others, especially if taken every day.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">For example, vasodilators like Nitrostat (nitroglycerin) and <\/span><a href=\"https:\/\/americanmigrainefoundation.org\/resource-library\/medications-linked-to-headache\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">antihypertensive agents<\/span><\/a><span style=\"font-weight: 400;\">, such as Diovan (valsartan), are known to cause headaches. Also, medications for pulmonary arterial hypertension, such as Uptravi (selexipag), may induce headaches due to their vasodilation effect.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Frequent headaches could also be a sign of a missed dose or lack of adherence to certain medications. For instance, patients may experience headaches and other uncomfortable withdrawal-like symptoms if they miss doses of an antidepressant like Paxil (paroxetine). To help assess adherence, check patients&rsquo; refill history and ask how they remember to take their medications. Suggest using pill organizers, medication reminders, or alarm clocks to help patients stay adherent.<\/span><\/p>\n<h3 id=\"medication-overuse-headache\"><span style=\"font-weight: 400;\">Medication overuse headache<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Ask patients living with chronic headaches about the OTC and prescription medications they take for headache relief and how often they take them.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medication overuse headache (MOH) occurs when people take acute headache medications often, leading to a vicious cycle of rebound headaches. This can happen with both prescription and non-prescription headache medications.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">MOH may cause tension-type or migraine symptoms. <\/span><a href=\"https:\/\/www.aafp.org\/pubs\/afp\/issues\/2014\/0415\/p642.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">This type of headache<\/span><\/a><span style=\"font-weight: 400;\"> may occur daily or nearly daily and can be caused by several medications, including analgesics. <\/span><a href=\"https:\/\/americanmigrainefoundation.org\/resource-library\/medication-overuse\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Analgesics<\/span><\/a><span style=\"font-weight: 400;\">, such as non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, can cause MOH when a patient takes more than the recommended daily doses and\/or takes the analgesics ten or more days per month.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The risk of MOH is highest with:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Opioid analgesics<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Combination drugs containing butalbital, such as Fioricet<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Combination medications containing acetaminophen\/aspirin\/caffeine, such as Excedrin<\/span><\/li>\n<\/ul>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/medication-overuse-headache\/\"><b>Medication overuse headaches, explained<\/b><\/a><\/p>\n<h2 id=\"non-pharmacologic-options\"><span style=\"font-weight: 400;\">Non-pharmacologic options<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Talk with your patients about lifestyle factors that could be contributing to their headaches. Several <\/span><a href=\"https:\/\/americanmigrainefoundation.org\/resource-library\/lifestyle-changes-for-migraine\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">lifestyle modifications <\/span><\/a><span style=\"font-weight: 400;\">may be beneficial for people with chronic headaches, such as:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hydrate with plenty of fluids every day.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Get adequate sleep.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Avoid dietary triggers.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Exercise regularly, as appropriate for your fitness level.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Limit caffeine intake.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Manage stress and make time for self-care.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Pharmacists can also encourage patients to track their headaches in a journal or health app. Recording headaches, symptoms, severity, and treatments can help patients and their healthcare providers evaluate whether the current treatment plan is working or if adjustments are necessary.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Pharmacists can also make a difference by counseling patients about the risks of overusing migraine and headache medications. <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC10597723\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Research<\/span><\/a><span style=\"font-weight: 400;\"> shows that simply educating patients about the potential risks of medication overuse headaches and medication withdrawal can reduce the frequency of headaches in patients with medication overuse headaches. Simple advice from a healthcare professional can lead to a reduction in medication use and an improvement in headache symptoms in patients with MOH.<\/span><\/p>\n<h2 id=\"otc-headache-treatments\"><span style=\"font-weight: 400;\">OTC headache treatments<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Common OTC medications used to treat headache pain include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">NSAIDs, such as <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/ibuprofen\"><span style=\"font-weight: 400;\">Motrin (ibuprofen) <\/span><\/a><span style=\"font-weight: 400;\">or <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/aleve\"><span style=\"font-weight: 400;\">Aleve (naproxen),<\/span><\/a><span style=\"font-weight: 400;\"> can effectively treat headache pain. Do not recommend NSAIDs for patients with cardiovascular problems, kidney impairment, or a history of gastrointestinal bleeding.&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Tylenol (acetaminophen)<\/span><span style=\"font-weight: 400;\"> can be recommended first-line for patients with headaches who cannot take NSAIDs.&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/excedrin-migraine\"><span style=\"font-weight: 400;\">Excedrin Migraine (acetaminophen, aspirin, and caffeine)<\/span><\/a><span style=\"font-weight: 400;\"> is beneficial in relieving headache pain. In a study of tension-type headaches, this combination product provided headache relief better and faster than acetaminophen alone&mdash;and allowed patients to resume their daily routines more quickly.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">As a pharmacist, patients will ask for your recommendation on the best OTC medication for relieving headaches. As always, before making a specific recommendation, pharmacists should review the patient&#8217;s other medications, allergies, and underlying conditions.<\/span><\/p>\n<h2 id=\"prescription-medications\"><span style=\"font-weight: 400;\">Prescription medications<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Prescription medications are used to manage headaches when non-pharmacologic and OTC options do not provide adequate relief. Two main types of prescription treatments are available for chronic headaches: prophylaxis to prevent headaches before they begin and abortive treatments to ease or stop headaches after they start. Common examples are described below.<\/span><\/p>\n<h3 id=\"prevention\"><span style=\"font-weight: 400;\">Prevention<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Healthcare providers may prescribe the following medications to <\/span><a href=\"https:\/\/www.healthquality.va.gov\/guidelines\/pain\/headache\/VA-DoD-CPG-Headache-Provider-Summary.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">help prevent migraine headaches<\/span><\/a><span style=\"font-weight: 400;\">:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Beta blockers, such as <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/tenormin\"><span style=\"font-weight: 400;\">Tenormin (atenolol)<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/lopressor\"><span style=\"font-weight: 400;\">Lopressor (metoprolol tartrate)<\/span><\/a><span style=\"font-weight: 400;\">, or <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/toprol-xl\"><span style=\"font-weight: 400;\">Toprol XL (metoprolol succinate, extended-release)<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30895388\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Antidepressants<\/span><\/a><span style=\"font-weight: 400;\">, such as <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/amitriptyline-hcl\"><span style=\"font-weight: 400;\">Elavil (amitriptyline)<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/nortriptyline-hcl\"><span style=\"font-weight: 400;\">Pamelor (nortriptyline)<\/span><\/a><span style=\"font-weight: 400;\">, or <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/venlafaxine-hcl\"><span style=\"font-weight: 400;\">Effexor (venlafaxine)<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Anticonvulsants such as <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/topiramate\"><span style=\"font-weight: 400;\">Topamax (topiramate)<\/span><\/a><span style=\"font-weight: 400;\"> or <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/depakote\"><span style=\"font-weight: 400;\">Depakote (divalproex)<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<\/ul>\n<h3 id=\"treatment\"><span style=\"font-weight: 400;\">Treatment<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Triptans are a mainstay of acute <\/span><a href=\"https:\/\/www.healthquality.va.gov\/guidelines\/pain\/headache\/VA-DoD-CPG-Headache-Provider-Summary.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">treatment<\/span><\/a><span style=\"font-weight: 400;\"> for migraine headaches. Examples of triptans include <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/imitrex\"><span style=\"font-weight: 400;\">Imitrex (sumatriptan)<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/zomig\"><span style=\"font-weight: 400;\">Zomig (zolmitriptan),<\/span><\/a><span style=\"font-weight: 400;\"> and <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/maxalt\"><span style=\"font-weight: 400;\">Maxalt (rizatriptan)<\/span><\/a><span style=\"font-weight: 400;\">. Healthcare providers prescribe triptans for stopping migraine headaches that are moderate to severe or have not been relieved with analgesics.<\/span><\/p>\n<p><a href=\"https:\/\/www.singlecare.com\/prescription\/migranal\"><span style=\"font-weight: 400;\">Migranal (dihydroergotamine)<\/span><\/a><span style=\"font-weight: 400;\"> and <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/ergotamine-tartrate\"><span style=\"font-weight: 400;\">Ergomar (ergotamine)<\/span><\/a><span style=\"font-weight: 400;\"> are ergotamine derivatives used for the <\/span><a href=\"https:\/\/www.healthquality.va.gov\/guidelines\/pain\/headache\/VA-DoD-CPG-Headache-Provider-Summary.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">acute treatment<\/span><\/a><span style=\"font-weight: 400;\"> of severe headaches.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Triptans and ergotamines have vasoconstrictive effects, so they should generally be avoided in patients with cardiovascular disease or uncontrolled hypertension. These medications also have significant drug interactions.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Analgesics may also be prescribed to treat headache pain on a short-term basis.<\/span><\/p>\n<h3 id=\"newer-therapies\"><span style=\"font-weight: 400;\">Newer therapies<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Small molecule <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22512641\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">CGRP receptor antagonists<\/span><\/a><span style=\"font-weight: 400;\"> are a newer drug class prescribed for <\/span><a href=\"https:\/\/www.healthquality.va.gov\/guidelines\/pain\/headache\/VA-DoD-CPG-Headache-Provider-Summary.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">prophylaxis and abortive<\/span><\/a><span style=\"font-weight: 400;\"> treatment of headaches. Examples include <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/ubrelvy\"><span style=\"font-weight: 400;\">Ubrelvy (ubrogepant)<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/nurtec\"><span style=\"font-weight: 400;\">Nurtec (rimegepant)<\/span><\/a><span style=\"font-weight: 400;\">, include <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/zavzpret?q=Zavzpret\"><span style=\"font-weight: 400;\">Zavzpret (zavegepant)<\/span><\/a><span style=\"font-weight: 400;\">. Unlike triptans, these medications <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22512641\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">do not have vasoconstrictive effects<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Another newer treatment is the selective serotonin receptor agonist <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/reyvow\"><span style=\"font-weight: 400;\">Reyvow (lasmiditan)<\/span><\/a><span style=\"font-weight: 400;\">. This medication is <\/span><a href=\"https:\/\/www.healthquality.va.gov\/guidelines\/pain\/headache\/VA-DoD-CPG-Headache-Provider-Summary.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">abortive only<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h2 id=\"when-to-refer\"><span style=\"font-weight: 400;\">When to refer<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Pharmacists can play a key role in knowing <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30536394\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">when to refer patients<\/span><\/a><span style=\"font-weight: 400;\"> to see a healthcare provider for further evaluation of chronic headaches. While rare, recurrent headaches may indicate a more serious condition. The following characteristics serve as red flags, typically warranting a referral to a healthcare provider or specialist if the patient meets one or more of the following criteria:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patient takes OTC analgesics for headaches more than three days per week.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patient has had a headache for 10 days or longer.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patient says the headache began following a head injury or accident.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patient is 55 years or older and experiencing headache symptoms or patterns that they do not usually have.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patient&rsquo;s headache begins within hours of stopping a particular medication.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patient is a <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/20666348\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">child<\/span><\/a><span style=\"font-weight: 400;\"> or adolescent.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patient is pregnant or breastfeeding.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Additionally, pharmacists should refer patients who present with headaches and concurrent symptoms of:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Fever<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Shortness of breath<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Stiff neck<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Rash<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Dizziness<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Seizures<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Confusion<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Vision changes<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Numbness<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Falling<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Difficulty speaking or moving<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Headaches are the most common type of pain, often requiring intervention with OTC medication. Pharmacists can play a key role in chronic headache management, including recommending OTC medications, lifestyle modifications, or counseling about the risk of medication overuse headaches. Pharmacists can also recognize when a patient may need specialized care and refer them to a healthcare provider for personalized medical advice.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Everyone gets a headache from time to time. According to the World Health Organization (WHO), an estimated 50%&ndash;75% of adults have had at least one headache in the past year. However, some people get headaches more frequently. Headaches are considered chronic if you experience 15 or more headache episodes per month for at least three [&hellip;]<\/p>\n","protected":false},"author":135,"featured_media":627016,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[9340],"tags":[808,743],"coauthors":[20937],"class_list":["post-627568","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-the-checkout","tag-pain-management","tag-pharmacies","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Counseling patients with chronic headaches<\/title>\n<meta name=\"description\" content=\"Many people suffer from chronic headaches, but there are many ways to work through the pain. 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