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Making headway with migraine

Pharmacists should avoid selling codeine products for migraine to prevent medication overuse

One in seven people suffer from migraine, yet research is still greatly under prioritised and under resourced. Dawn Gay investigates the important role for pharmacists in championing migraine and headache treatment

This year’s Migraine and Headache Awareness Week is due to run from September 5-10 and Migraine Action is partnering with Nurofen for Children to deliver a campaign highlighting the conditions in younger sufferers. The campaign, which launched this summer in the run up to
the awareness week, includes support and educational tools to help community pharmacies bring migraine under control in the earlier years.

Simon Evans, chief executive of Migraine Action, explains that supporting young people is a key focus for the charity: “The campaign seeks to educate pharmacy teams on the prevalence of headache in children, especially those aged seven-plus – when it becomes the most common form of pain – and provide support in pharmacy to achieve better outcomes in children’s headache management. With the help of pharmacy staff, we hope to improve the patient experience of these prevalent conditions which can have a dramatic impact on the sufferers’ quality of life.”

The partnership follows a successful in-store campaign with the launch of Nurofen for Children Chewable Capsules in February. The orange-flavoured, pharmacy category, pain relief is formulated for children aged seven to 12 years who have outgrown liquid painkillers. The new ibuprofen capsules are supported by a £2 million TV, digital and PR campaign that kicks off this month.

Gurinder Chohan, brand manager for Nurofen for Children, adds: “We know as children grow older and become more independent, parents face new challenges when it comes to managing their child’s pain. At this age, children can feel they have outgrown liquid pain relief but struggle
to swallow a tablet. With the launch of Nurofen for Children Chewable Capsules, we are offering parents an age appropriate on-the-go pain relief solution that children are comfortable taking.”

Advice and resources

The National Migraine Centre, a charity offering support and treatment for migraine sufferers, offers a range of comprehensive online factsheets, as well as migraine diaries, to download from its website: www.nationalmigrainecentre.org.uk. The charity emphasises that pharmacists should avoid selling codeine products for migraine to prevent medication overuse. Around 40 per centre of patients attending the centre have issues with medication overuse headaches.

Migraine events for healthcare professionals

The European Headache and Migraine Trust International Congress (EHMTIC) is being held from September 15-18 at the Scottish Exhibition and Conference Centre in Glasgow (www.ehmtic2016.com).

Migraine Action runs Migraine Insight events on diagnosis, treatments and therapies, listed at www.migraine.org.uk. Forthcoming events include:

  • Birmingham Migraine Insight, September 10, Birmingham NEC
  • London Migraine Insight, October 15, Quakers Friends House, London

The National Migraine Centre runs a series of annual migraine master classes in London, delivered by headache specialists and neurologists. The charity is also happy to run bespoke talks to groups of pharmacists. See its website for details.

The British Association for the Study of Headache (BASH) does not recommend any codeine-containing compounds for the treatment of headache or migraine. Codeine exacerbates the gastric stasis, which is common in migraine.

Codeine is also frequently implicated in medication overuse headaches, explains Judith Pearson, the National Migraine Centre’s specialist doctor. This can occur in anyone using acute medication to treat their symptoms on more than 12-15 days per month for three months or more, and is the commonest cause of chronic daily headache. “Rather than advising customers to use codeine-containing compounds, a non-steroidal anti-inflammatory, used on fewer than 12 days per month, would be more useful,” says Dr Pearson.

Bristol Laboratories, which produces Migraitan 50mg sumatriptan migraine relief tablets, is offering migraine questionnaire pads and training guides for pharmacists and pharmacy assistants. The resources can be obtained from www. bristol-labsconsumercare.co.uk/healthcare- professionals or info@bristol-labs.co.uk.

The alternatives

Studies show that magnesium deficiency is common among migraineurs. And a recent trial on BetterYou Magnesium Oil spray conducted by Migraine Action and BetterYou Magnesium Spray revealed that the frequency and severity of migraines may be reduced with the transdermal application of magnesium.

During the three-month trial, 100 migraineurs who experience at least three attacks per month, were instructed to apply BetterYou’s Magnesium Oil Original spray. The participants were asked to apply the spray 10-20 times per day and log the incidence and severity of their migraines during this time.

Around half of the 72 respondents felt that the magnesium spray had a positive effect on their migraine symptoms and experienced a decrease in the severity of their attacks. A third of the participants thought that it reduced the duration of their attacks.

BetterYou’s founder and managing director Andrew Thomas explains: “The results of this trial with Migraine Action are invaluable to our ongoing campaign to raise awareness about magnesium deficiency and its links with migraine. Just 10 sprays of BetterYou’s Magnesium Oil spray deliver a minimum of 150mg of elemental magnesium which will help play a role in overall general health.” Pharmacists looking for a practical option to ease the symptoms of headache and migraine could consider stocking a range of cooling eye mask products, for example, the Thera Pearl Eye-ssential Mask launched last November.

Research spearheaded by the founder of the US National Headache Foundation found that 71 per cent of patients suffering from acute headaches found a frozen gel pack to be an effective form of pain relief. During another US trial, 28 migraine patients used a cold gel pack for 25 minutes during two migraine attacks and reported a 50 per cent reduction in symptoms. 

Guidelines on migraine and headache treatment

  • Screening Pharmacists and counter staff can respond to customer interest or elicit a headache history from those wishing to purchase analgesics
  • Education and commitment The pharmacy can display posters and leaflets on headache and the staff can discuss sources of further information with patients
  • Differential diagnosis Pharmacists can use a screening questionnaire to diagnose the patient into the appropriate headache subgroup
  • Assessment of illness severity Pharmacists can question patients to ascertain the severity of the headache and associated symptoms, and limitations to daily activities. They can categorise the migraine into mild-to-moderate or moderate- to-severe intensity
  • Tailoring management to individual patient needs Patients with tension-type headaches and mild-to-moderate migraine can be treated by the pharmacist with over- the-counter medication. Those with moderate-to-severe migraine, chronic daily headache or possible sinister headache are best referred to their GP.
  • Proactive long-term follow-up Patients should be encouraged to return to the pharmacy for review of illness severity and their response to treatment.

From Migraine Action’s Migraine in Primary Care Advisors (MIPCA)




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