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Christine Glover, BSc, FRPharmS,
is proprietor of Glovers Integrated Healthcare, Edinburgh
Sally
Greensmith, MRPharmS,
worked for Guildford and Waverley Primary Care Trust when this article
was researched
and written. She then moved to the National Prescribing Centre for two
years until March 2007. The article did not form part of her role with
the NPC. She is now community pharmacy development lead for South East
Coast Strategic Health Authority
Alison Ranftler, MRPharmS, is a
community pharmacist, in Northwich, Cheshire
Gillian Donkin, BPharm,
MRPharmS, is a
community pharmacist
in Woking, Surrey
Lisa Jamieson, MSc, MRPharmS, is
lead prescribing support pharmacist at Surrey Heath and Woking
Primary Care Trust
Peter Charlesworth, MSc, MCOptom,
is an optometrist and director
of replay learning, in Thornhill, Dumfries and Galloway
Ann Turner is a former
director of the Migraine Action Association
Andrew Dowson, MBBS,
PhD, is director of the King’s Headache Service Correspondence
to:
Dr Dowson at King’s College Hospital,
Denmark Hill, London
SE5 9RS |
Further information
Patient support group
Migraine Action Association
Migraine in Primary Care Advisors
Pharmacists
interested in headache are encouraged to join MIPCA, either from
the website or by contacting
Rebecca Salt at Merrow Park Surgery, Kingfisher Drive, Merrow, Guildford,
Surrey GU4 7EP
tel 01483 450755; fax 01483 456740
Migraine Trust
Migraine and headache resources |
SUMMARY
Pharmacists are likely to have an enhanced role in headache management
in the future after the switch of drugs, such as sumatriptan, from prescription
only (POM) to pharmacy (P) medicine status.
NHS reform is providing an opportunity for pharmacists to expand their
role by becoming supplementary and independent prescribers or by providing
minor ailments services in community pharmacies: this is now a core service
in Scotland.
The main challenges for implementing a pharmacy-run headache service
are the provision of training and management algorithms, payment for
these enhanced services and auditing their success. The guidelines presented
here put a framework in place to help pharmacists manage headache better.
The
guidelines may be customised for use by other healthcare professionals,
such as dentists, opticians and complementary practitioners.
Headache is a widespread condition, with estimates of 93 per cent of
the population experiencing one or more headaches in their lifetimes,
while 11 per cent of men and 22 per cent of women have a headache at
any point in time. The most frequently reported headaches are the benign
primary headaches of episodic tension-type headache (TTH), episodic migraine
and chronic daily headache (CDH, now categorised primarily as chronic
migraine and chronic TTH, together with some rarer headaches).
CDH comprises daily or near-daily headaches that last for more than four
hours on average, often linked to medication overuse. In the UK overuse
of products that contain codeine, such as Nurofen Plus, Solpadeine and
Syndol, may be a major contributor to medication overuse headache (MOH).
Patients often do not realise these drugs contain codeine and it can
be a problem to identify codeine users in pharmacy practice. However,
it is worth taking time to establish whether codeine is implicated. CDH
usually arises from a primary, episodic headache disorder (migraine or
TTH). Other headache subtypes are relatively uncommon, affecting less
than 1 per cent of the population.
For such a common condition, it might be expected that effective healthcare
services would be available to treat most sufferers. Unfortunately, this
is not so, and headache remains under-recognised, under-diagnosed and
under-treated in primary care. In particular, half or more of migraine
sufferers do not consult a physician, remain undiagnosed and rely on
over-the-counter (OTC) medicines. This means that many of them pass
through the doors of community pharmacies for treatment.
There is a need for best practice guidance for the pharmacist on how
to manage patients with headache. Recently, evidence-based guidelines
for the management of migraine in primary care have been developed in
the UK, US and Canada, and for chronic headaches in the UK. From
the UK guidelines, recommendations have been published to help nurses
and patients to manage migraine. This article describes the development
of headache guidelines for pharmacists in the UK.
The UK headache guidelines initiative was co-ordinated
by the Migraine in Primary Care Advisors (MIPCA) charity, which is dedicated
to the improvement of headache services in primary care in the UK. Pharmacy
headache guidelines were developed at a MIPCA meeting of pharmacist,
GP and nurse members, in association with the UK patient support group
Migraine Action Association.
Drafting the guidelines involved extensive input from community pharmacists,
pharmacy advisers, an optometrist, GPs and nurses. Research included
literature searches accessed via MedLine, monitoring of relevant presentations
at international headache and neurology congresses and outputs sourced
from the Department of Health and the Royal Pharmaceutical Society.
Full text article (PDF 100K) |
The
Pharmaceutical Journal