Tension headaches generally affect the forehead area. The pain is bilateral and like a band squeezing the head. Patients who experience onset of tension headache without prior history meet the criteria for self-care and can be treated effectively with acetaminophen or NSAIDS.
Migraines differ from tension headaches as the pain can be unilateral or bilateral. Patients often experience an aura prior to migraine attack where visual changes are reported. Additionally, migraines can cause nausea. When evaluating migraines for self-care pharmacists should consider frequency (less than 2x a week) as criteria for self-care. Also note whether the patient has attempted any prior therapy. Patients who have failed OTC regimens or who have frequent migraines are candidates for referral.
Sinus headaches are caused by congestion and are accompanied by pressure near the forehead or cheekbones. Pressure makes these areas tender to palpation. Patients with sinus headaches are candidates for self-care if they do not present with any pressing signs of infection. Patients who have fever, malaise, extended
duration of the symptoms should be referred. If patient is a candidate for self-care, recommend acetaminophen or NSAIDS for abortive therapy as well as pseudoephedrine as a decongestant.
Acetaminophen or NSAIDS (Ibuprofen & Naproxen Sodium) should be the first OTC abortive analgesics recommended. Doses of 1000mg acetaminophen every 8 hours, ibuprofen 200mg every 6 hours, and 220mg naproxen sodium every 12 hours have similar analgesic relief. While aspirin can also be used as an analgesic for headaches, the dose needed is associated with toxic effects and therefore not recommended for headache.
When choosing between acetaminophen and NSAIDS, consider their respective black box warnings. Acetaminophen is hepatotoxic at high doses exceeding 4 grams and should be avoided in cirrhotic patients. NSAIDS have 2 black box warnings of increased risk of cardiac events and risk of damage to the GI mucosa. Treatment with NSAIDs should be avoided in patients with CVD (high cardiac event risk) and patients with increased risk of stomach bleed. Aside from the high risk patients mentioned above, acetaminophen or NSAIDs can be used with equal efficacy in treating headache.