Page 137 - Community pharmcy practice E-book 2025

02/11/2025, 00:29

Pain management

1. Headache

Etiology
• Headaches may be broadly classified as primary (e.g., tension-type, migraine, cluster) or
secondary (due to underlying pathology such as infection, trauma, tumour, medication-overuse).
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• Typical triggers include stress, dehydration, poor sleep, caffeine (over-use or withdrawal),
medication-overuse (analgesics) and local factors (eyesight strain, neck posture). ( )
• Pharmacist role: recognise when headache is simple/self-treatable vs when it might be
secondary (red flags) and thus require referral. ( )

Symptoms
• Pain in the head or face: may be throbbing, sharp, dull, pressure-type. ( )
• May be accompanied by photophobia, phonophobia (in migraine), nausea, neck stiffness,
or aura.
• Often variable in frequency, intensity, location (unilateral vs bilateral) depending on type.

Referral Cases (Red Flags)
The pharmacist should refer the patient (or advise seeking medical attention) if:
• Onset is sudden and severe (“thunderclap” headache) or the “worst ever”.
• New headache in older age (>50), or change in pattern of existing headache.
• Headache accompanied by focal neurologic signs (weakness, speech disturbance), visual
changes, new seizures.
• Headache after trauma (especially head injury).
• Headache with fever, stiff neck, rash (possible meningitis) or systemic signs (weight loss)
or in immunocompromised.
• Evidence of medication‐overuse headache: frequent analgesic use (>10-15 days/month)
causing rebound.

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