2017 HCHB_digital

Headache
Headaches are common and can be triggered by a number of different things.
The term headache refers to any pain that occurs in the head or upper neck.
Headaches are classified into different types, depending on the location of the
pain, how severe it is, how long it lasts, how often it occurs, and sometimes what
brings on the pain. Knowing what type of headache a customer has can help in the
management and treatment of their headache. Most headaches are self-limiting and
usually resolve themselves, with or without treatment.
Analgesics are available over the counter (OTC), and stronger analgesics and
other treatments are available as pharmacist-only medicines or on prescription
from the doctor.
The following questions can help determine what sort of headache the customer is
suffering and whether or not an OTC product is suitable.
• Where is the pain?
»»
Frontal pain: headache, sinusitis.
»»
Back of the head: tension headache.
»»
Unilateral (on one side): sinusitis, migraine, shingles (around eye or scalp),
trigeminal neuralgia (on side of face).
»»
Within the eye: acute glaucoma.
»»
Behind the eye: sinusitis, shingles (around eye or scalp), migraine.
»»
Temple area: arteritis (inflamed temporal artery).
• What is the pain like?
»»
Sudden pain like a blow to the head: haemorrhage.
»»
Throbbing, pounding: fever, migraine.
»»
Constant, nagging: tension headache.
Initial assessment and warning signs
Many customers request assistance from pharmacy staff when choosing a
headache medicine. Asking a few Refer to Pharmacist questions can help you
decide which customers are amenable to self-treatment and who needs to be
referred to the pharmacist. Warning signs that demand an immediate referral are:
• headaches described as “the worst headache of my life” (needs urgent
medical attention, even if the person habitually suffers from headaches)
• a first headache in a person over 50
• headaches that worsen over time (months) or a new or different headache
• headaches that are severe right from the start
• headaches that develop after a head injury or major trauma
• headaches brought on by lying down, a cough, bending or with certain
activities (eg, weightlifting, jogging, sex).
TREATMENT OPTIONS
Category Examples Comments
Simple analgesics
Non-steroidal antiinflammatory
drugs (NSAIDs)
Combination analgesics
Natural / herbal products /
supplements
[GENERAL SALE]
eg, paracetamol (Panadol, Panadol Rapid*, Paracare* [up to
20 tablets])
[PHARMACY ONLY MEDICINE]
eg, paracetamol (larger pack sizes) (Panadol, Panadol Rapid*,
Paracare*, Panadol Optizorb*)
[GENERAL SALE] eg, aspirin (Aspro, Disprin), ibuprofen up to
25s (Advil, Nurofen*, Nurofen Zavance*)
[PHARMACY ONLY MEDICINE]
eg, diclofenac (Voltaren Rapid 12.5*), ibuprofen >25s
(Advil, Nurofen*, Nurofen Zavance*, Nurofen Zavance Liquid
Capsules), naproxen (Sonaflam*)
[PHARMACIST ONLY]
eg, diclofenac (Voltaren Rapid 25*)
[GENERAL SALE] eg, paracetamol + caffeine (Panadol Extra)
eg, ibuprofen + paracetamol (Maxigesic* [16], Nuromol* [12])
[PHARMACY ONLY MEDICINE]
eg, paracetamol + caffeine (Parafast Extra [36]),
eg, ibuprofen + paracetamol (Maxigesic*, Nuromol*)
[PHARMACIST ONLY MEDICINE]
eg, paracetamol + codeine (Panadeine, Panadeine Extra),
ibuprofen + codeine (Nurofen Plus*), paracetamol +
doxylamine + codeine (Mersyndol)
Butterbur, caffeine, cayenne, feverfew, peppermint
Products with an asterisk have a detailed listing in the Headache section of OTC Products, starting on page 241.
Effective for most people with very few adverse effects. Avoid duplication of
paracetamol-containing medications (present in combination cold/flu and sinus
products).
NSAIDs generally last longer than paracetamol. Ibuprofen is the NSAID least
likely to cause stomach irritation. NSAIDs may not be suitable for people on
certain other medications or with some medical conditions (eg, asthma, kidney
disease – see Refer to pharmacist). Advise customer to stop taking if stomach
upsets, increased bruising or prolonged bleeding occur. Aspirin products require
the same warnings as other NSAID products. Aspirin is not recommended for
adolescents or children under 12 years old, or for children under 16 years old with
a viral-related fever, or fever with chickenpox (see Childhood Pain and Baby
Teething: Treatment options). See also Reference Section, OTC Medicines
– Precautions.
Try simple analgesics and NSAIDs first.
Warn customers codeine is an addictive substance and should not be used for more
than three days at a time. Constipation or drowsiness may also occur. Monitor
sales and be alert for any customers who may be misusing codeine-containing
preparations.
Mersyndol also contains doxylamine, so can cause drowsiness.
See also Migraine.
Caffeine in combination with analgesics is effective at relieving simple headache.
Several other natural remedies have been used for headache relief.
CHOOSE PANADOL WITH OPTIZORB
FOR ADVANCED ABSORPTION *
*FASTER ABSORPTION COMPARED WITH STANDARD PARACETAMOL TABLETS.
Panadol ® with Optizorb ® Formulation contains 500mg paracetamol per tablet/caplet. Indications and dosage: For the temporary relief of pain and fever. Adults and children 12 years: 1 – 2 tablets/caplets every 4-6 hours (maximum 8 tablets/caplets in 24 hrs). Children 7 –12 years: ½ – 1 tablet/caplet every
4-6 hours (maximum 8 tablets/caplets in 24 hrs). Contraindications: Patients with a previous history of hypersensitivity to paracetamol or to any of the excipients; in children under 7 years. Adverse reactions (very rare): Thrombocytopenia; anaphylaxis, cutaneous hypersensitivity reactions including skin rashes,
angioedema and Stevens Johnson syndrome; bronchospasm, especially in patients sensitive to aspirin and other NSAIDs; hepatic dysfunction. Panadol, Optizorb and the beacon device are registered trade marks of the GSK group of companies or its licensor. GSK Auckland, NZ. TAPS NA 9036. CHANZ/CHPAN/0135/17.
Voltaren Rapid 25 390x45.indd 3
Page 88 HEALTHCARE HANDBOOK 2017-2018 Common Disorders