Role and impact of over-the-counter medications in the management of headache.

The use of nonprescription medication for primary headache in the general population is highly prevalent. The trend toward self-care is likely to increase in the era of health care reform. Physicians may underestimate the efficacy of nonprescription products because most patients who seek consultation have not had good result with their use. The vast majority of people with headache pain find relief from self-treatment with OTS products and are not involved in ongoing care. All nonprescription analgesics are potentially effective and safe; benefits include cost-effective treatment, and liabilities include ineffective treatment, unnecessary suffering, and inappropriate use that results in a variety of side effects. Such side effects include overuse that contributes to chronic daily headache. Patients and physicians need to recognize that nonprescription medication is medication and regard it as such. Physician inquiries during history taking must include the use of OTS medication because patients are confronted with a wide array of choices and often select such agents randomly or on the basis of advertising claims. Patients need to be educated about ingredients, efficacy, safety, side effects, drug interactions, and appropriate use. Physician recommendations regarding dosing and frequency help to avoid overuse syndromes and adverse events. A step-care approach in managing the acute headache is helpful, starting with the simple analgesics, moving to combination products, and finally to prescription products. All this is best done in the climate of a physician/patient partnership characterized by mutuality of effort and responsibility.