Pharmacists can offer guidance on medication overuse for patients with headache disorders, migraines

Pharmacists can offer guidance on medication overuse for patients with headache disorders, migraines

A session presenter at the 2022 ASCP Annual Meeting explained how mishandling of headache medications by patients can lead to rebound headaches.

Headache disorders are painful and debilitating and can cause considerable personal suffering and affect patients’ quality of life, explained Sharon F. Clackum, PharmD, BCGP, CDM, FASCP, during a session at the 2022 Annual Meeting of the American Society of Consulting Pharmacists (ASCP). In addition, Clackum explained that there is also a significant financial cost to patients with headache disorders, not only in the treatment of headaches, but also in time lost from work due to decreased productivity.

“The physical, emotional and socioeconomic burdens of headaches are not well understood,” Clackum said. “There are not many studies that tell us exactly how much that financial burden is. [for the patient with headache disorders].”

When determining the type of headache a patient has, Clackum said it’s necessary to rule out possible common local causes, such as neck, sinus or ear pain. Once these local causes are excluded, primary headache is the most likely diagnosis, Clackum explained.

Furthermore, the most essential component in effective management of headache disorders is becoming aware of the underlying problem, what triggers the headaches, and then understanding the symptoms.

“It takes longer to recover without a correct diagnosis, and this is sometimes difficult to do,” Clackum said. “If you don’t have very differentiating symptoms, sometimes it’s difficult for the doctor to diagnose it, especially in primary care. They will usually refer you to a headache specialist or neurologist.”

In addition, Clackum noted that it’s also important to avoid mismanagement of headache medications, because too much medication can cause rebound headaches in patients.

“And this is where the pharmacist comes in, because they can use their background in medicine to make sure rebound headaches don’t happen,” Clackum said. “If he understands how headaches work, then he can advise patients not to take too much medication so they can avoid rebound headaches.”

In addition, Clackum explained that pharmacists can advise patients to limit their use of over-the-counter pain relievers, and especially decongestants.

“People who have a lot of allergies in the spring and fall tend to overuse decongestants, and then there will be rebound headaches,” Clackum said. “You want to restrict decongestant use to no more than 3 days per week to avoid medication overuse headaches.”

Additionally, pharmacists can counsel patients on the importance of trying to limit caffeine intake to lessen the occurrence of headaches. Specifically, if patients drink 2 cups of coffee a day or 2 soft drinks a day, this should decrease the potential for headaches caused by too much caffeine.

“I know people who have had 6 cups of coffee for lunch,” Clackum said. “So if you have constant headaches, you should limit your caffeine intake and any fluctuations in caffeine intake.”

Pharmacists may also advise patients with headache disorders against the use of opioids for pain. Specifically, studies have been conducted to assess the efficacy of opioids in treating headache-related pain, and the data showed that opioids are not as effective as nonsteroidals.

“Then we should try to educate against the use of [opioids for headache pain] as much as we can,” Clackum said.

In addition, Clackum explained that there is not enough evidence to show the efficacy of using SSRIs to treat headache disorders. Clackum noted that more data would be valuable in assessing the impact of commonly prescribed medications on headache disorders, as there is a lack of data consistent with the widespread nature of headache occurrence in the general population.

“Migraines are the third most common illness in the world and the leading cause of neurological disability,” Clackum said. “I have seen patients who have literally lost 4 out of 5 days in a week [due to headache disorders].”


Clackum SF. Headaches: Tension, Sinusitis, Migraine… Oh my God!! Presented at: American Society of Consulting Pharmacists (ASCP) Annual Meeting 2022 in San Antonio, TX; November 5, 2022.

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