Pharmacists can offer advice on medication overuse for patients with headaches and migraines

A session presenter at the 2022 ASCP Annual Meeting discussed how patients’ mismanagement of headache medications can lead to rebound headaches.

Headaches are painful and debilitating and can cause significant personal suffering and impair patients’ quality of life, explained Sharon F. Clackum, PharmD, BCGP, CDM, FASCP, during a session at the annual meeting 2022 from the American Society of Consultant Pharmacists (ASCP). . Additionally, Clackum explained that there is also a significant financial cost to headache patients, not only in headache treatment, but also due to lost time at work due to decreased productivity.

“The physical, emotional, and socioeconomic burdens of headaches are poorly recognized,” Clackum said. “There aren’t many studies that tell us exactly how much this financial burden is [for the patient with headache disorders].”

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

Additionally, the most essential element of effective headache management is becoming aware of the underlying problem, what is triggering the headaches, and then understanding the symptoms.

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

Additionally, Clackum noted that it’s important to also avoid the mismanagement of headache medications, as too much medication can cause patients to experience rebound headaches.

“And that’s where the pharmacist comes in, because you can use your experience in medicine to make sure rebound headaches don’t happen,” Clackum said. “If you understand how headaches work, you can advise patients not to take too many medications to avoid rebound headaches.”

Additionally, 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 spring and fall allergies tend to overuse decongestants, which will lead to rebound headaches,” Clackum says. “You want to limit the use of decongestants to no more than 3 days per week to avoid medication overuse headaches.”

Additionally, pharmacists can advise patients on the importance of trying to limit their caffeine intake to decrease the onset of headaches. Specifically, if patients shoot for 2 cups of coffee per day or 2 sodas per day, this should reduce the risk of headaches caused by over-caffeination.

“I know people who drank 6 cups of coffee for lunch,” Clackum said. “So if you have constant headaches, you need to limit that caffeine intake and any fluctuation in caffeine intake.”

Pharmacists can also advise patients with headaches not to use opioids for pain. Specifically, studies have been conducted to assess the effectiveness of opioids in the treatment of headache-related pain, and data has shown that opioids are not as effective as nonsteroidals.

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

Additionally, Clackum explained that there is not enough evidence showing the effectiveness of using SSRIs for the treatment of headache disorders. Clackum noted that more data would be useful to assess the impact of commonly prescribed medications on headache disorders, as there is a lack of data commensurate with the widespread nature of headache onset in the general population.

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


Clackum SF. Headaches: Tension, Sinus, Migraine… Oh My!! Presented at the 2022 American Society of Consultant Pharmacists (ASCP) Annual Meeting in San Antonio, TX; November 5, 2022.

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