Margaret presents to the pharmacy seeking a recommendation for treating persistent headaches that she has been experiencing.
The pharmacist notes that the patient has been visiting the pharmacy routinely for the past 2 months.
Margaret Meets with the Pharmacist
Based on the patient’s history, we discover that Napuli:
- Reports a “dull” and “throbbing” headache for the past 2 months after falling in gymnastics class
- Rates her pain a 2-3 out of 10, sometimes reaches a 5
- Received a CT scan at time of injury that revealed no skull or jaw fractures
- Receives minimal relief from current medication including acetaminophen, naproxen, ibuprofen, and codeine
- Is self-medicating with mother’s prescription migraine medication
- Pharmacist noticed that the patient was purchasing OTC analgesics very frequently.
- Overuse of OTC Analgesics of concern when patient is using OTC analgesics for > 15 days per month
- Patient questioned to determine the amount of acetaminophen, naproxen, ibuprofen, and aspirin she is taking daily and weekly.
Medication Overuse Headache
Definitions for Diagnostic Criteria:
- Headache present on >15 days per month
- Regular overuse for >3 months of one or more
- Acute/symptomatic treatment drugs
- Headache developed or worsened during medication overuse
Definition of Medication Overuse Depends on Drug Class
- Ergotamine, triptans, opioids, or combination analgesic preparations
- >10 days per month on a regular basis for >3 months
- Simple analgesics or any combination of acute headache treatments
- >15 days per month on a regular basis for >3 months
Olesen J, Bousser MG, Diener HC, et al. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia 2006; 26: 742-746.
Although the definition specifies medication use for >3 months, the pharmacist is being proactive in identifying a potential problem of medication overuse at 2 months.
At the pharmacist’s recommendation, Margaret and her mother visit Margaret’s primary care physician.