Despite their ready familiarity with analgesics, customers do benefit from receiving the right advice about the management of their headache

Headaches and migraine affect most people in the UK at some point, so it’s not surprising that this is an important category for pharmacies, with pharmacy teams advising customers on headache management on a daily basis. In recent months, the safety of ibuprofen and paracetamol has hit the headlines. Scaremongering media reports linked the longterm use of the nation’s two most popular analgesics to an increased risk of high blood pressure and heart problems, even though the risks involved were very small.

According to NHS Choices, some of these media reports could cause needless alarm. Pharmacy customers may need greater reassurance and advice on choosing the right analgesic for their symptoms, particularly when it comes to the more powerful pharmacy-only (P) medicines.

Stepped approach

Analgesics are most effective if they’re taken as soon as pain strikes, according to experts. In July 2015, consumer research by Nurofen Express and Migraine Action revealed that one in five headache and migraine sufferers believes their treatment will work better if they wait until their symptoms are unbearable before seeking pain relief, reinforcing the importance of responsible advice from healthcare professionals. Nurofen Express partnered with charity Migraine Action to launch a campaign highlighting the need for better management of headache and migraine, and the role of pharmacy in facilitating change.

According to Craig Shaw, Nurofen marketing director, pharmacists have a critical role to play when advising customers about pain relief. “A key role for the pharmacist is to help their customers choose the right product, so that they can improve their treatment regime,” he says. “This is important because research shows only around one in five people is obtaining sufficient relief from the analgesics they are using. Moreover, other research demonstrated that pain sufferers in the UK treat their pain by taking analgesics on only 50 per cent of all pain occasions.”

Grzegorz Przeczek, marketing manager at Omega Pharma, says the opportunities for pharmacy to successfully deliver the self-care agenda for headache and migraine are even more paramount with P-medicines playing a central role. “For pain that is not relieved with a single active ingredient alone, pharmacists should suggest a combination product,” he says.

“Pharmacists and counter staff should encourage the responsible use of codeine-based products for short-term pain and direct customers to the product information leaflet for information on the recommended dose. It’s important to offer a broad choice of pain relief in a variety of forms to cater to the individual needs of pain customers. To help refresh pharmacy teams’ knowledge of the category, pharmacists and assistants can access the pain category and Solpadeine training modules on Omega Pharma’s newly updated training portal.”

Alternative options

According to the most recent NICE Clinical Pathway (updated in June 2015), analgesics are still the first-line treatment for tension-type headaches and migraine. But taking analgesics for headaches on more than two to three days a week can lead to medication-overuse headache. Pharmacists need to be able to advise on and offer, other approaches, from dietary measures to non-drug options, for customers with frequent headaches. Some people prefer to treat their headaches naturally, choosing cooling patches, or lavender or peppermint sticks.

Others may benefit from stress management strategies. Carl Ryan, brand manager at Pharmed Group, says pharmacies should respond to changing customer requirements. “Customers are becoming more aware of what they want,” he says.

“They tend to research alternative treatments or products online and ask for these by name in store. We have qualified staff who provide product training to pharmacies. Pharmacy staff find this very beneficial, as they can interact with the product and with the trainer.

Migrastick is a cooling roll-on medical device. “Migrastick is constantly updating its social media channels [via Arkopharma] and supporting pharmacies by sharing and retweeting pharmacy offers, promotions and updates. Point-of-sale materials in various sizes have been created to suit customer needs as well as consumer information leaflets and shelf displays,” he adds.

Dr David Mantle, medical adviser to nutritional supplements company Pharma Nord, says that pharmacists should consider dietary supplements for headache and migraine relief, as research continues to confirm their benefits. “There is evidence that migraines are associated with mitochondrial dysfunction and deficiency of a naturally occurring vitamin-like substance called coenzyme Q10,” he says.

“Several clinical studies have demonstrated that supplementation with CoQ10 significantly reduces the frequency of migraine attacks and associated vomiting, making the substance particularly important for those who experience regular headaches. Based on its review of efficacy, CoQ10 received a strong recommendation as a prophylactic drug from the Canadian Headache Society.”

Non-medicated alternatives

In September 2015, a survey by Cefaly UK, an electronic anti-migraine device, revealed that one in 10 migraine sufferers spends £1,200 annually in an attempt to relieve their symptoms. Many others are spending more than £40 a month on migraine treatments, from painkillers and cooling patches to physiotherapy and exercise. The survey was run in association with the National Migraine Centre.

Cefaly is a small headband that applies precise neurostimulation at the centre of the forehead onto the supraorbital nerve, which has been implicated in migraine activity. Patients wear the device for 20 minutes every day as a preventive measure or use it at the start of a migraine attack. Studies have shown that 38 per cent of patients who used Cefaly reported at least a 50 per cent reduction in their migraine frequency. At £250, Cefaly is an expensive outlay, and pharmacy teams will need to know the product’s benefits if they’re going to promote it to customers.

BHR Pharmaceuticals offers training and advice to pharmacies who wish to offer it as an option. “The pharmacist needs a device to show customers, which we make available at a reduced cost,” says Bharat Vadukul, business manager of BHR Pharmaceuticals, the UK distributor of Cefaly.

“After that, they simply ring in an order for delivery to them when a patient agrees to buy the device. Many of our clients tell us that they have spent a huge amount of money over the years treating their migraines, often to no avail. Cefaly, a once-in-a-lifetime purchase, provides good value for money compared to other non-prescription treatments and has robust and independent research to back up its efficacy.”


Severity and cost of migraine is underestimated

Workers are losing an estimated 25 million work days each year due to migraines, with an estimated 610,000 people suffering from the condition in the UK, according to figures released by The Migraine Trust. Employees are suffering lengthy absences from work, reducing their productivity by more than 50 per cent and costing the economy £2.25 billion a year.

The figures also showed that migraines are also costing a further £150 million due to the cost of medication. The symptoms are so severe that the World Health Organisation (WHO) categorises the condition at the same level of disability as dementia, quadriplegia and acute psychosis. The WHO also classes chronic migraines at a higher level of disability than blindness, rheumatoid arthritis and paraplegia angina.



Vishal Mahru, VM Pharmacy Services, Leicester “If patients are coming to us before GPs about headache, it’s crucial that we get that first diagnosis right or as close to right as possible. Patients are coming to us a lot more and I’ve tried to look at the different headaches or migraine to improve my understanding. We need to have a more holistic approach than in the past, where it might have just been “here is your paracetamol or ibuprofen and there you go”. I think people are suffering more with headaches. Mostly people don’t understand the cause of their headache and don’t necessarily know the difference between a headache and migraine. So, we have to encourage people to talk about their symptoms to be able to give them the right advice.”


Rena Dadra, Village Pharmacy, Harlington “This is obviously a category where people want something that works, and advice alone is not enough. If they have a severe headache, they want to buy something to sort it out as soon as possible. But we need to ask the right questions to find out more – for example, if they’re driving or working we can’t give them codeine – so training is very important. Our counter assistants are properly trained to help advise patients correctly, to give the right product to the right patient, and we’ve recently trained everyone up again. My biggest frustration is around the codeine combinations; that people don’t understand that these really aren’t good for them. People think it’s okay to have codeine every day, but we have to warn them that they can’t do that and they should see a doctor.”


Coll Michaels, Calverton Pharmacy, Luton “We’ve remerchandised all our medicines recently to make sure we have representative facings for all the big products. It’s a big category for, but our business in this category isn’t on the increase. We can’t compete on price with the supermarkets because we just don’t get the footfall to make up for what we’d lose on price. It would be a pointless exercise. We have a healthy trade in specialist migraine products such as Migraleve, and general analgesics. Unfortunately in our area there are a few people who we know are habitual painkiller users. They’re very smart and they’ve got ten pharmacies in a very small area to choose from so it’s very hard to know exactly what’s going on.”


The benefits of GP ‘recommendation prescriptions’

Receiving a recommendation for self care from the GP would make a huge difference to patients, says PAGB’s John Sm...

Case study: Dementia-friendly care

Barnton Pharmacy's innovative approach to dementia care all comes down to good customer service, says Sally Arnison