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Almost three quarters of headache sufferers don’t seek professional advice. This represents a huge opportunity for pharmacy staff to offer help and support, as Victoria Goldman explains

A recent report from Nurofen Express, called ‘Rethinking Tension Headache’, reported that 40 per cent of consumers experienced a headache at least once a week and 67 per cent experienced a headache once a month or more. Nearly three-quarters of consumers in the survey said they wished they could deal with the pain more effectively, yet many of them didn’t seek professional advice.

Dr Terry Maguire, community pharmacist at Maguire Pharmacy in Belfast, says that pharmacy staff play a key role in helping consumers manage their headache symptoms. “Over half of those surveyed by Nurofen Express never consulted a healthcare professional about treatments for their headache,” he says. “But despite consumer hesitancy to seek medical advice, 53 per cent of consumers in the survey said they would be happy for a member of the pharmacy team to approach them with advice and support. What’s more, 76 per cent commented that new information on the treatment of headache would impact on how they dealt with head pain.”

Around 42 per cent of consumers would be encouraged to try a new product if their pharmacist or doctor recommended it

Most headaches can be treated with over-the-counter analgesics, but it’s important that customers are buying the right products to suit their needs. According to Jacki Beesley, Numark’s retail marketing executive, pharmacists should provide professional advice with every analgesic product sold, even if the patient doesn’t ask for it. “By offering advice within this category, pharmacists will benefit from ensuring the customer is walking away with an appropriate treatment, therefore increasing customer loyalty,” she says. “The idea is not to sell more analgesics but to sell appropriately, and to capture customers that may simply go elsewhere should they not have the benefit of interaction with a member of the pharmacy team.”

Headache types

Before deciding on an appropriate analgesic, pharmacists need to establish which type of headache the customer is suffering from. There are four main types of primary headache – tension-type headache, migraine, cluster headache and medication overuse headache. Tension-type headaches are what most people consider to be a normal everyday headache, affecting 80 per cent of people from time to time. They are usually described as a tight pressure-like feeling around the head, or a weight on top of it.

Migraine tends to cause a throbbing pain at the front or side of the head, often accompanied by nausea, dizziness and increased sensitivity to light and sound. Cluster headaches are the most severe, causing attacks of pain on one side of the head, often behind the eye. The pain is so unbearable that sufferers often bang their head against a wall out of frustration and despair. Medication overuse headaches are frequent or daily headaches caused by taking analgesics for tension-type headaches or migraine on 15 or more days a month.

Resolving the confusion

According to a spokesperson for Solpadeine, customers can be confused by the choice of analgesics available, so pharmacists and their staff should speak to customers about their headache symptoms in order to recommend the most suitable pain relief. “By going through the WWHAM questions, pharmacy teams can assess the symptoms the customer is experiencing, how long they have been suffering, and what medication they are currently taking,” she says.

This information will help pharmacy teams tackle some of the challenges facing the pain relief category, such as reluctance to treat, selecting the wrong treatment, sub- therapeutic dosage and incorrect or overuse of treatments. The Solpadeine training module provides more details on the different types of pain and can help pharmacists identify the most appropriate treatment to recommend.

Dr Maguire suggests asking a few simple questions. “Ask the customer to detail the areas and form of the headache – this will enable you to start to establish the type of headache they are experiencing,” he says. “Are they taking any medicines that might be causing the headaches? Exactly what do they mean by the headache? Is it pulsating, suggesting vascular headache? Or is it across the head and pressing, suggesting tension- type headache? A headache over one eye and of short duration may suggest cluster headache but this is quite rare, at 0.1 per cent of the population. Also, how long does the headache last? And are they doing anything that could be making it worse, such as poor posture?”

Analgesic choice

When a headache strikes, it is important to treat it straight away. Yet 70 per cent of those surveyed by Nurofen Express waited 20 minutes or more before taking medication for their headache. Evidence suggests that failure to treat tension-type headaches quickly and effectively can increase nerve sensitivity and the possibility of the pain becoming chronic.

Tension-type headaches may be caused by muscle tension in the neck and head. According to Dr Maguire, many people are not treating their headaches effectively, with 86 per cent commenting that a recommendation from their pharmacist could impact on the medication they purchase.

British Association for the Study of Headaches guildelines recommend ibuprofen as a first-line treatment for tension-type headaches. But research shows that pharmacists are more likely to recommend paracetamol than ibuprofen for headaches. Paracetamol can only target the central pain pathway and has a lesser impact on tension- type headache, says Dr Maguire.

A Mintel report on ‘Analgesics in the UK’ published in June 2014 revealed that around 42 per cent of consumers would be encouraged to try a new product if their pharmacist or doctor recommended it. The top motivations for trying a new analgesic are largely to do with effectiveness: nearly half of analgesics users agree that they would be motivated to try a new product if it was proven to work faster. A further 35 per cent said they would be willing to try a new product if it was the strongest pain reliever they could find, while another third said that they would try a new product if it offered pain relief that lasted longer than other products.

Stock brand leaders

“Pharmacies should stock brand leaders within the analgesics category, covering all relevant active ingredients, ie, paracetamol, ibuprofen, aspirin, codeine, etc. And, where appropriate, triptans for migraine,” says Ms Beesley. Pharmacists should also ensure they have an own-label representation of each of the drug types where relevant, and position these directly next to the branded counterpart for maximum sales potential, she adds.

The analgesics category is profitable but, more importantly, pharmacy-only analgesics represent around 40 per cent of the total P medicines category. This category lends itself to pharmacy interventions, something patients don’t get from the supermarkets, says Ms Beesley. Eight ‘migraine-specific’ products rank within Numark’s top 300 selling products in independent pharmacy – all of these products are P medicines.

Considering the category layout within pharmacy can help drive sales of headache and migraine remedies. “Pain relief options should be divided by brand and segmented by active ingredient, to help customers navigate the category shelves and find what they need easily.” Pharmacies can also make the most of cross-purchasing opportunities by positioning other relevant categories next to pain relief, eg, cold and flu or sleep and stress.

Looking ahead

The Mintel report concluded that analgesic brands could move into other sectors to create preventative headache products. And also that 18 per cent of consumers would be motivated to try a new product if it contained natural ingredients. Mintel recommended that analgesic brands could branch into the beauty and personal care market, for example, creating bath and body products to prevent and treat headaches.

The Solpadeine spokesperson suggests locating the fixture in a prominent position, with relevant point-of-sale materials to help customers make an informed choice. “It’s important for pharmacists to stock a range of pain management options, including first-line single active treatments such as ibuprofen and paracetamol, as well as combination products,” they say. “Pharmacy teams can also share lifestyle tips with customers, which should be implemented alongside taking pain medication. Advice could include drinking more water, applying a hot flannel on their forehead and adjusting their posture, which can all help to ease the pain of headaches.”