The Pharmacist’s Role in Counseling Patients on Migraine Treatments

Pharmacists play an important role in educating patients with migraine on the proper use of both OTC and prescription medications, according to a recent review.

Most patients with migraine do not receive a correct diagnosis and appropriate care, so they have a greater reliance on OTC treatment and prescription analgesics, wrote Rebecca Barnhart, PharmD, clinical pharmacist at UC Health in Denver, Colorado, and colleagues in a recent Drugs & Therapy Perspectives article.¹

In fact, one study reported that 49% of patients exclusively used OTC medications for acute treatment of migraine, whereas 29% reported use of both OTC and prescription medications.

“While some OTC acute medications may be useful for migraine, patients who use acute medications too frequently can develop medication overuse headache (MOH),” the authors wrote in the study. “Importantly, patients need to understand the risks of overusing acute medication.”

Pharmacists are well-placed to support patients with migraine, “because they are extremely accessible health care professionals, with patients commonly seeking their advice,” according to the authors. In fact, results of 1 survey demonstrated that 97% of community pharmacists made 1 or more OTC recommendation daily for the treatment of headaches.

The community-based pharmacist is often the only health care professional that some patients with migraine visit, the authors noted. “Up to one-third of those with migraine do not consider migraine a disease and, therefore, do not consult a primary care physician,” they wrote.

Pharmacists can use a simple 4-question algorithm to advise patients on OTC medications and other factors. They can ask about the percentage of headaches prohibiting normal activities and/or accompanied by vomiting, headache-free days per month, symptoms that accompany headaches, and the OTC products that have been tried.

In addition, pharmacists can identify those who, based on headache frequency and disability level, would benefit most from physician referral and possible preventive treatment.

"With a unique view of both OTC and prescribed medicines, the community pharmacist is well-placed to detect medication overuse,” the authors added. 

Pharmacists can also counsel patients to avoid lifestyle factors that may contribute to disease progression. For patients on prescription medications, pharmacists could do more to provide medication-specific education and advice.

“The pharmacist may also have a role in providing information on nonpharmacologic treatment options including the identification and avoidance of triggers, an important area where pharmacists could have greater input,” the authors said. 

In patients under the active management of a physician, pharmacists can support the prescriber by selecting the most appropriate acute or preventive therapy based on patient-specific factors including comorbidities, identifying adverse events, and managing drug-related problems, such as potential drug-drug interactions.

“When working in collaboration with the physician, the pharmacist may also have a role in medication management, which in relation to migraine could involve managing the tapering or discontinuation of acute medicines, particularly in patients presenting with MOH or whose migraines are being managed with opioids or barbiturates,” the authors concluded. 

Reference

1. Patel N, Barnhart, R, Konkol P, et al. Treatment of migraine: a review of disease burden and an update on the therapeutic landscape for pharmacists. Drugs & Therapy Perspectives. December 5, 2020. https://doi.org/10.1007/s40267-020-00801-