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module menu icon Headache and migraine consultations

HEADACHE AND MIGRAINE CONSULTATIONS

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IN PRACTICE

  • W

    Susan is in her late 30s

  • W

    She has a headache and the back of her neck feels quite tender to touch

  • H

    Her headache started about mid-morning when she was at work

  • A

    She took a couple of paracetamol tablets when her headache started (more than 4 hours ago). They helped relieve her headache a bit.

  • M

    She isn't taking any other medicines but has had a stomach ulcer in the past

Read each of the following 'What if...' questions then select the correct response.

She says that her headache is a dull ache and feels like a band around her head. She wonders if it could be stress-related as she has been under pressure at work and hasn't been sleeping very well recently. Choose from the options below what you think could be wrong.

a. It could be a tension headache and you can recommend an appropriate pain relief product 10

It sounds like Susan has a tension headache, which is the most common type of headache, and may have been triggered by stress and tiredness. Other triggers include smells, noise and poor posture.

Symptoms include a dull ache that feels like a band around the head, pain that is the same on both sides of the head and muscles in the back of the neck may feel tight.10 Self-care advice you can give includes:

  • Try to relax as stress can make headaches worse
  • Apply a cool flannel to the forehead
  • Maintain good posture and keep hydrated

b. It could be migraine and you can recommend an appropriate pain relief product

Migraine usually only affects one side of the head. The pain from migraine tends to be more severe and customers may describe their headache as being pounding, throbbing or pulsating. Some customers with migraine may also experience nausea, vomiting and/or increased sensitivity to light (photophobia) and sound (phonophobia).11

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c. It could be something more serious and you should refer her to her GP as a matter of urgency

Susan hasn't mentioned any symptoms that would be a cause for concern or urgent referral. If a customer describes any of the following, they should be referred urgently to A&E:

  • Headaches associated with a recent head injury
  • Headaches that come on suddenly and are extremely painful
  • Extremely painful headaches with additional symptoms such as affected vision, the white part of the eye is red, drowsiness or confusion, problems speaking or any signs of meningitis.12

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She tells you she wants something that will work quickly. She says that she doesn't take painkillers very often, but she has tried co-codamol in the past and they made her quite constipated. What pain relief from the list below would you choose?

a. Ibuprofen capsules

As she has a previous history of a stomach ulcer, ibuprofen would not be the most suitable choice.

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b. Paracetamol and codeine capsules

Codeine can cause drowsiness/constipation. Also, she wants a fast-acting product, so a soluble formulation may be more appropriate.

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c. Paracetamol and caffeine soluble tablets

Soluble tablets can get to work faster than paracetamol alone* The addition of caffeine may help speed up the absorption of paracetamol.6 None of these ingredients cause constipation so this would be the most appropriate recommendation.

*based on absorption data

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