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Migraine in Primary Care Advisors

MIPCA Projects

Pharmacist education on headache management

Headache is a large public health problem, with many sufferers never consulting a GP, remaining undiagnosed and relying on sometimes unproven over-the-counter (OTC) treatments. Many headache sufferers consult a pharmacist for care and MIPCA has therefore developed evidence-based guidelines for the pharmacist on the management of migraine and other headaches.

Existing guidelines for headache management contain seven principles of care, adapted for use by the pharmacist and their counter staff:

  1. Screening: pharmacist and counter staff can respond to customer interest or elicit a headache history from those wishing to purchase analgesics.
  2. Patient education and commitment: the pharmacy can contain posters and leaflets on headache, and the staff be willing to discuss sources of further information with patients.
  3. Differential diagnosis: a simple to use and validated diagnostic screening questionnaire is available that enables the pharmacist to categorise the patient into the subgroups of episodic tension-type headache (TTH), migraine, chronic daily headache (CDH) or possible sinister headache.
  4. Assessment of illness severity: three simple questions on the severity of the headache and associated symptoms, and limitations to daily activities allows the categorisation of the headache into mild-to-moderate or moderate-to-severe intensity.
  5. Tailoring management to the needs of the individual patient: patients with TTH and mild-to-moderate migraine may be treated by the pharmacist with OTC medications. Those with moderate-to-severe migraine, CDH or possible sinister headache are best referred to the GP.
  6. Proactive, long-term follow up: patients should be encouraged to return to the pharmacy for review of illness severity and response to treatment.
  7. A team approach to care: a partnership between the GP service and the pharmacist allows for efficient communication and facilitates the patient journey of care. 

These guidelines may be able to be customised for use by other healthcare professionals (e.g. dentists, opticians and complementary practitioners). Guidelines for the optician have recently been published (see News section).

Pharmacists are likely to have an enhanced role in headache management in the future, following the switch of some drugs from prescription only (POM) to pharmacy prescription (P) status, and by becoming supplementary prescribers for POM drugs. Sumatriptan 50 mg tablets are now available to sell OTC with a pharmacy prescription. The main challenges for implementing a headache service are the provision of appropriate training and management algorithms, payment for these enhanced services and auditing of their success.


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Slide Set

Pharmacy Algorithm