aware
WELL Duquesne University Mylan School of Pharmacy
UPDATE from the Center for Pharmacy Care
November-December 2004
Basic facts about Headaches
H
eadache is one of the most common of health complaints and is responsible for approximately 18 million patientphysician visits each year. Headache is defined as a pain felt in the forehead, temple, or deep within or at the base of the skull. Each year, the direct and indirect costs of this problem range from $6-$18 billion. It is estimated that migraine sufferers miss more than 157 million work days each year. Direct costs include physician office visits, prescription and nonprescription drugs, hospitalization, etc. Indirect costs can be attributed to lost earnings, decreased production, and reduced employee efficiency. There are two main types of headache: primary and secondary. Primary headaches are the most prevalent and include types known as tension, migraine, and cluster. These account for more than 90% of all headaches. The remaining 10% are categorized as secondary and generally are caused by underlying medical conditions such as infection, tumor, etc.
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Types of Primary and Secondary Headache Tension-type headaches occur in about 75% of primary headache sufferers and are often triggered by stressful events. This form of headache presents with a steady ache that affects both sides of the head. In some individuals they occur infrequently, while in others, this type of headache occurs on a daily basis. Migraine headaches are common as well. It is estimated that 24 million Americans have experienced a migraine at least once in their lives. Migraines are three times more frequent in females (18%) than males (6%) up to the age of approximately 45 years. After this age, the incidence is evenly distributed. Signs and symptoms associated with migraine include a throbbing type of pain usually felt on one side of the head. Pain may be so severe it can debilitate the patient. Migraine headaches may or may not be accompanied by an aura. An aura may be defined as a visual disturbance
that appears as flashing lights, zig-zag lines, or a temporary loss of vision that precedes or accompanies the attack. Nearly 15-30% of migraine headaches are accompanied by an aura (Formerly known as “classic” migraine – migraines not associated with an aura were previously referred to as “common” migraine). The attacks tend to be occasional, but can occur up to twice weekly. Seldom do they occur on a daily basis. Migraines are the main focus of both symptomatic and preventive treatment algorithms. (See online version of Well Aware for comparison of symptoms of tension and migraine headaches.) Cluster headaches develop in approximately 1% of the population. They usually affect males and occur in groups or clusters lasting weeks and possibly up to one month. The pain associated with cluster headaches is extremely severe. continued on back
Mark Your Calendar NOVEMBER • November 8 & 15, 2004, 9:00 a.m.-1:00 p.m. Center for Pharmacy Care Wellness Mondays • November 17, 2004, 9:00 a.m.-1:00 p.m. Cholesterol & Diabetes Screening Please call 412-396-5874 for an appointment.
All events will be held in the Center for Pharmacy Care, Room 320 Bayer Learning Center, unless otherwise noted.
DECEMBER • December 6 & 13, 2004, 9:00 a.m.-1:00 p.m. Center for Pharmacy Care Wellness Mondays • December 1 & 15, 2004, 11:00 a.m.-1:00 p.m. Migraine Screening & Blood Pressure Screening Location: Union, 3rd Floor Concourse
• November 10 & 17, 2004, 11:00 a.m.-1:00 p.m. Migraine Screening & Blood Pressure Screening Location: Union, 3rd Floor Concourse CENTER FOR PHARMACY CARE – Wellness Mondays
Please call x5874 to RSVP for screenings and lunchtime lectures.
The Center offers the following complimentary screenings on Mondays by appointment: Bone Density, Body Composition Analysis, Facial Skin Analysis, Cholesterol Screening Please call 412-396-5874 for an appointment.
www.duq.edu
Basic facts about Headaches Fortunately, the attacks are brief, generally lasting no more than 1-2 hours. Cluster headaches develop around one eye, sometimes resulting in the eye becoming watery and inflamed. This may result in nasal congestion. Cluster headaches are also known as “alarm clock” headaches because they seem to strike at the same time each day; sometimes in the middle of the night. Rebound headaches are a result of the excessive use of pain relievers. These headaches occur as the last dose of medication starts to wear off. Rebound headaches most likely occur in people with tension-type or migraine headaches.
When to contact your physician? • If you have 3 or more headaches per week • If you take an OTC pain reliever almost every day or regularly exceed the recommended dose • If you have a stiff neck or fever in addition to a headache • If your headache is accompanied by shortness of breath, and/or unexpected symptoms that affect your ears, nose, eyes, or throat • If you are dizzy, unsteady, or have slurred speech, weakness, or changes in sensation (numbness and/or tingling) in addition to your headache • If you experience confusion, drowsiness, or vomiting with your headache • If it is triggered by exertion, coughing, bending, or sexual activity • If your headaches have changed in character • If your headaches began after you reached the age of 50
• Physical: changes in sleep pattern, injury, overexertion • Smoking • Stress: work, home, family
What are your treatment options? Treatment is based on the type, severity, frequency, and duration of your headaches. There are pharmacologic and non-pharmacologic methods to manage your particular type of headache. Lifestyle modifications or alternative practices may help alleviate the intensity or even reduce the number of attacks one may experience. Some examples are included below. Others may be obtained from your physician or from the Web sites included at the end of this article.
Lifestyle Changes • Avoid known triggers • Eat regular meals • Exercise regularly • Maintain regular sleep patterns • Reduce stress • Smoking cessation
Alternative Therapies • Acupuncture • Massage • Meditation • Relaxation techniques
Pharmacologic Therapy There are many different guidelines for the treatment and prevention of migraine headache. Mild to moderate attacks can be effectively treated with aspirin, acetaminophen, and/or non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen. These products are available without a prescription. Other NSAIDs are available by prescription. Migraine attacks may require the use of ergot alkaloids (for example Cafergot, etc.), serotonin receptor agonists (“triptans” such as sumatriptanImitrex, etc.), and butorphanol (Stadol). Combination products include isometheptene, dichloralphenazone, and acetaminophen (Midrin) or a popular product containing butalbital and acetaminophen (Fioricet, etc). Severe headaches unrelieved by these therapies may response to narcotic analgesics. Anti-emetics may be used to treat the nausea and vomiting sometimes associated with migraine. Preventive therapy (“prophylaxis”) should be considered if recurring migraines produce significant disability. Selected based on individual response and tolerability, prophylactic medications should be given an adequate trial period (usually 2-3 months) to determine their effectiveness. (One suggested method for migraine management is incorporated into the online version of Well Aware.)
For more information on symptoms and treatments of headaches, visit the online version of Well Aware.
www.pharmacy.duq.edu/
Common Triggers • Dietary: certain medications/foods, alcohol, skipping meals • Emotional: changes in mood such as depression, anxiety, frustration, letdowns • Environmental: changes in weather, allergies, bright lights, certain odors/ pollution, loud noises • Hormonal: changes in estrogen levels
Newsletter Contributors John G. Lech, Pharm.D. Elisa J. Choe, Pharm.D. Candidate Fred W. Gardner, Pharm.D. Candidate
Additional information regarding headaches may be obtained by visiting the following Web sites: • www.i-h-s.org
• www.nlm.nih.gov/medlineplus/headache.html
• www.achenet.org
• www.ninds.nih.gov/health_and_medical/disorders/headache.htm
A publication of the Duquesne University Mylan School of Pharmacy Pharmacy Care Awareness Program (PCAP) & Pharmaceutical Information Center (PIC) Additional information on any of the topics discussed may be obtained from the Pharmaceutical Information Center by calling 412-396-4600 or sending an e-mail to pic@duq.edu. Questions about screenings or programs: Christine O’Neil, Pharm.D, B.C.P.S. 412-396-6417 10/04 cg 302131
Migraine Headaches–Symptoms and Treatments Symptoms of Tension and Migraine Headaches* INTENSITY & QUALITY OF PAIN
TENSION
MIGRAINE
mild — moderate pain
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moderate — severe pain
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steady ache
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distracing; not debilitating
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intense, pounding, throbbing, +/- debilitating LOCATION both sides of head
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one side of head ASSOCIATED SYMPTOMS nausea/vomiting
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sensitivity to light and/or sound
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aura
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* Adapted from the American Council for Headache Education
Guideline for Treatment and Prevention of Migraine* * From: http://secure.pharmacytimes. com/lessons/html/migraine.htm (accessed 2004 October 5)