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Headache Headaches are

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

CONTINUING OTC EDUCATION • symptoms such as fever, high blood pressure, muscle aches, weight loss, or scalp tenderness (may suggest a whole body disorder) • seizures, confusion, slurred speech, memory loss, loss of balance, changes in consciousness or difficulty waking. Common types of headache Migraine A migraine typically occurs just on one side of the head, with the pain usually starting as a dull throb or tightening which then intensifies into a concentrated and severe pain (see Migraine for more information). Tension headache Tension headaches are the most common type of headache. Described as a mild, aching pain that occurs on both sides of the head, the back of the head, or as a tight band across the forehead, this headache tends to worsen as the day goes on, or if the person is stressed. Avoiding eye strain or bad posture and using relaxation techniques or massage to manage stress may help reduce the number of tension headaches. Lying down in a warm, darkened, quiet room may also help. Most tension headaches respond to OTC pain relief. Sinusitis Blocked nasal passages can lead to sinusitis, where mucus is unable to drain causing pressure build-up and pain. Sinusitis is usually associated with a cold (see Colds), and often causes a frontal headache or aching teeth. Bending, coughing, or sneezing can make the headache worse. Decongestants and pain relief may relieve the symptoms but antibiotics may be needed if the cause is due to a bacterial infection. Rebound headaches Rebound headaches (medication-overuse headaches) are caused by taking pain-relieving medicines too frequently for headaches. They are the third most common cause of headache after migraine and tension-type headaches. Avoidance of pain-relief tablets for a period of time is necessary to revert the headaches back to a normal pattern. Non-medicine-related, self-help measures (see advice for customers) may help during this period of pain-relief avoidance. Refer to PHARMACIST Seek urgent medical advice for anybody with warning signs (see text). The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, heart or lung problems, immunosuppression, diabetes, is pregnant or breastfeeding)? • Does the person take any other medication, either prescribed by a doctor or bought from a shop or supermarket (including herbal/ complementary medications)? • Have the symptoms persisted despite treatment with adequate doses of analgesics or lasted longer than 24 hours? • Is the person a child under 12? • Is the person elderly with a recurring headache originating from the temples (may be temporal arteritis)? • Does the person have a fever, rash or a stiff or sore neck (see Childhood Diseases and Immunisation: Meningococcal disease). • Are there any other symptoms (eg, nausea, visual disturbances)? • Does the person have frequent headaches (more than one a month) and/or is buying a lot of analgesics? • Does the person have any allergies to medicines? Advice for customers • Identify and avoid factors that trigger the headache if possible. • Rest in a quiet, darkened room. Reusable heat pads may provide relief. • Be careful not to overuse pain-relief medicines. • Drink plenty of water, maintain regular exercise and a healthy diet. • Try muscle relaxation exercises, or spend at least half an hour each day relaxing (eg, listening to music, reading). • Track your headaches. »» Keep a diary of when headaches occur to help identify their cause. THINK PARACETAMOL TABLETS ARE ALL THE SAME? PANADOL WITH OPTIZORB® STANDARD PARACETAMOL 10/04/17 5:17 pm Page 89

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