Headache and migraine brands are focusing more heavily on the suitability of their products for treating different types of headache. Helping people to make the right choice is key

Some 80 per cent of adults have episodic tension headache and 15 per cent have migraine. Research by Nurofen Express found that 40 per cent of us experience headache at least once a week and 67 per cent once a month or more. Migraine causes 190,000 attacks a day in the UK, says the Migraine Trust, making it more prevalent than diabetes, epilepsy and asthma combined. Yet less than 50 per cent of sufferers consult a doctor for diagnosis or advice.

Some 45 per cent of pharmacists surveyed by Nurofen Express believes patients are mistreating their headaches.

Research by the All-Party Parliamentary Group on Primary Headache disorders has found the number of A&E admissions for headache has increased by 12 per cent in the past three years, making it the most common neurological reason for attendance. ‘The evidence examined by the inquiry revealed that poorly informed and unsupported headache patients are misusing NHS services as they seek a firm diagnosis, appropriate treatment and support,’ says the report. It’s clearly an area where pharmacy staff could play a more active role.

Right advice

Many headache and migraine patients won’t see their GP, but rely on OTC remedies from pharmacies, so you’re in a good position to spot chronic headache and migraine sufferers and ensure they get the correct advice and treatment.

‘First and worst headaches seen in the pharmacy need medical input. If the pattern is progressive, it’s best to refer to their GP, but if it’s stable then a coherent strategy by pharmacy could be very successful,’ says Dr Andrew Dowson, director of headache services at Kings College hospital, and chair of the Migraine in Primary Care Advisors (MIPCA) group and spokesperson for Migraine Action. ‘The most common type of headache in the community is low-impact, tension-type headache and these respond well to OTC analgesia if given early. Most data points to NSAIDs rather than paracetamol. Migraine is next most common and many will respond to OTC remedies, too, but up to 50 per cent might benefit from specific migraine treatments, such as sumatriptan 50mg,’ says Dr Dowson. ‘If pharmacists are confident identifying these headaches their management can defuse patient problems and reduce inappropriate self-referral to A&E. Other unusual types of headache are best referred to the GP.’

Guidance

MIPCA has produced updated guidelines on headache management for pharmacists (www.mipca.org.uk/pdf/newsletters/ NL21_Pharmacist.pdf) on how to handle headaches for pharmacists. These include:

• Screening. Take a headache history from the customer
• Patient education. Display posters, leaflets, discuss sources of further information
• Differential diagnosis. A screening questionnaire is available to help pharmacists categorise a customer’s headache
• Assessment of illness severity. Find out how intense pain is; how frequent attacks are
• Tailor management to the patient’s needs. Know when to safely treat and when to refer
• Proactive long-term follow up. Encourage patients to return to review response to treatment
• A team approach between pharmacist and GP gives best results.

Headache type

‘A pharmacist should first establish whether the headache is something more significant by asking a series of questions such as what type of pain is present, whether there are other symptoms and what medication has already been taken. By effective use of questions and establishing a rapport with the customer, you can guide the customer to the most suitable product,’ says Gill Stone, NHS standards pharmacist at the Co-Operative Pharmacy.

Nurofen marketing director Craig Shaw believes pharmacists are in a unique position ‘as the only professionals with evidence-based clinical knowledge combined with information on cutting-edge formulations. By working in partnership with patients to understand their needs, pharmacists can make a real difference to life pain management. Techniques such as motivational interviewing can be used to work with patients to understand the psychological impact of pain. This individualised approach puts the pharmacist at the centre of the conversation. Asking open-ended questions and using listening skills, rather than relying on WWHAM-style questions and answers, followed by a product sale, will result in a more satisfying outcome.’

At Numark, Emma Charlesworth says: ‘A patient’s lifestyle can be a contributing factor to recurring or sudden onset of headaches. As well as recommending an analgesic, pharmacists should try to understand if there are any underlying factors causing the headaches. Pharmacists can play an important role in helping customers better manage their pain by recognising repeat purchasers and approaching them to discuss whether their treatment is appropriate.’

A spokesperson from Solpadeine at Omega Pharma comments: ‘It can be difficult to selfdiagnose the type of headache or migraine and therefore difficult to identify the most suitable pain relief, leaving customers overwhelmed. Pharmacists can support customers to make an informed choice, ensuring the right pain relief is recommended.’

For category growth

Stocking well-known brands that deliver fast, effective results is key, as is correct understanding and diagnosis by the pharmacist,’ says Mr Shaw. A pain management module can be found at the www.RBforhealth.com portal.

‘Pharmacy teams can look at the category layout to help drive sales, ensuring the fixture is in a prominent position. Pain relief options should be divided by brand and segmented by active ingredient,’ says a spokesperson for Solpadeine. Consider introducing relevant POS to help customers make informed choice at point of purchase and make the most of link sale opportunities by positioning other relevant categories next to pain relief.

‘By improving knowledge of the products available you can confidently recommend the most suitable product,’ says Ms Stone.

‘Stock brand leaders which cover a range of pain relief options and also an own label representation of each of the drug types where relevant. GSL lines should be on open display to facilitate self selection. Merchandise the pain category by brand and format with pack sizes merchandising left to right and from large to small,’ advises Ms Charlesworth at Numark.

Market news

Nurofen Express targets headache faster than paracetamol or ibuprofen. It will be backed by Nurofen’s biggest campaign next year (worth £4 million), which will focus on educating consumers on the causes of headaches. According to a survey by Nurofen Express, 53 per cent of consumers would be happy for a member of the pharmacy team to approach them with advice and support on managing headaches.

Numark has developed a Counter Excellence training module, which covers common headache types.

Omega Pharma has updated its interactive online training portal www.omegapharmatraining. co.uk to better support pharmacy.

A new device to prevent migraine has been approved for sale by the FDA. Called Cefaly, it uses TENS to help reduce frequency and duration of attacks.

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