Pharmacists can play a big role in helping patients treat migraines, which are recognized as a common neurological disorder that affect both adults and children globally and are ranked sixth as a cause of disability by the World Health Organization.1

Migraines affect about 39 million men, women, and children in the United States and about 1 billion people globally.2 However, migraines may be underdiagnosed and undertreated.2

The prevalence of migraines generally peaks between ages 25 and 55 years.

A migraine is defined as a unilateral throbbing headache that presents with or without symptoms of aura (sensory or visual), nausea, or photophobia.3 The typical symptom of the pulsing or throbbing headache increased with movement or physical activity and can worsen over a period of 1 to 2 hours.3 The symptom presentation of a migraine is not always the same, so the management approach should depend on this presentation. Migraines are also more common in women and are thought to have a strong genetic component.3 When it comes to helping manage migraine symptoms, health care professionals, including pharmacists, can helping patients achieve some degree of relief and improvement in quality of life by informing them about the condition and steps to take for lifestyle interventions and medication use.

Migraine Diagnosis
When it comes to diagnosing migraines, there is no specific test used. Instead, a diagnosis is largely dependent on a neurological assessment, a thorough evaluation of an individual’s medical history, and ruling out other diagnoses.4 In order to provide a comprehensive diagnosis, information should include the assessment of the family history of headaches, the clear features of the presenting headaches, and the impact that the headaches have on the patient’s ability to engage in or perform daily activities.4

Migraines Impact
Migraines can affect almost every aspect of life, including academic, occupational, and social, even when those who suffer are not having an episode.5 Timely diagnosis and ongoing management of symptoms are the keys to managing migraines.

Pharmacist Role
Because they are so accessible, pharmacists are in a pivotal position to help patients either achieve relief with self-treatment or refer more serious cases to physicians.6 Pharmacist should talk to patients who think they may suffer from migraines about their headache history, the type of pain experienced, as well as the duration, frequency, intensity, and location of symptoms. If a patient describes the headache as more continuous or long-term, a referral to a medical provider for diagnosis would be warranted.7

If a patient is diagnosed with a migraine, a pharmacist can work closely with the individual to educate them about how to control acute attacks and the use of preventative therapies to reduce the number of migraines. In addition, pharmacists should inform patients about the continuous evaluation of their therapies as a standard of their care to determine effectiveness of treatment.7 Pharmacists should also follow up with patients once they are initiated on medications to assess the effect on controlling symptoms. In addition, pharmacists can inform patients about questionnaires or tools that assess migraine severity, as well as advising them to keep diaries to monitor the frequency and the severity of the attacks to help guide treatment approaches in coordination with medical providers.7 Finally, pharmacists should assess patients’ understanding of the benefits and possible adverse effects of their medication therapies and how long it may take to achieve a desired effect.7

Conclusion
Migraines can be a chronic condition for many individuals, but they do not have to severely affect quality of life if patients are properly informed about symptom identification and presentation. Pharmacists can help provide education and guidance on how to manage symptoms to help patients maintain their quality of life.
 
Abimbola Farinde, PharmD, is a pharmacist at Cornerstone Hospital in Houston, Texas, and an adjunct professor at Grand Canyon University’s College of Nursing and Health Care Professionals in Phoenix, Arizona.

References
  1. Aliani J. Migraine in the United States: updates in epidemiology. Neurology Times. July 25, 2019. neurologytimes.com/ahs/migraine-united-states-updates-epidemiology. Accessed May 8, 2020.
  2. Migraine facts. Migraine Research Foundation website. migraineresearchfoundation.org/about-migraine/migraine-facts/. Accessed May 8, 2020.
  3. Chawla J. Migraine headache. Medscape. February 28, 2020. emedicine.medscape.com/article/1142556-overview. Accessed May 8, 2020.
  4. Diagnosis. The Migraine Trust website. migrainetrust.org/living-with-migraine/seeking-medical-advice/diagnosis/. Accessed May 8, 2020.
  5. Burton WN, Landy SH, Downs KE, Runken MC. The impact of migraine and the effect of migraine treatment on workplace productivity in the United States and suggestions for future research. Mayo Clin Proc. 2009;84(5):436‐445. doi:10.1016/S0025-6196(11)60562-4.
  6. Pray WS. Patients with headaches: The pharmacist’s role. U.S. Pharmacist. January 26, 2009. uspharmacist.com/article/patients-with-headaches-the-pharmacists-role. Accessed May 12, 2020.
  7. Smiley T. The role of the pharmacist in identification, referral, and management of migraine headache. CE Compliance Centre National Continuing Education Program. canadianhealthcarenetwork.ca/files/2009/10/NovoCE_Dec05_E.pdf. Published December 2005. Accessed December 12, 2020.