Pharmacist Insights: Migraine Medications

Head pain is responsible for fewer than 5% of acute medical care, however, migraines affect more than 1 billion people worldwide. Migraines typically involve recurring episodes of pulsing or throbbing pain on either side of the head, along with nausea, vomiting, and/or sensitivity to light and sound.

If left untreated or unsuccessfully treated, migraine pain can last from hours to days and can be moderate to severe, often becoming debilitating.Migraines can cause 1.3 years of a patient’s life to be lost to debilitating discomfort.The condition is frequently multifactorial and patient-specific, causing accessible patient care and treatments to be limited and ignored.

Patients with chronic headaches have a 2.49-fold greater risk of suicidal ideation and are 3 times more likely to experience depression. The negative health outcomes associated with migraines provide an opportunity for pharmacists in the inpatient and outpatient settings to support patients experiencing migraines.

Migraines have a genetic component, as 4 of 5 patients with migraines have a family member who experiences them as well. If a parent has migraines, their offspring has a 50% chance of having them, which increases to 75% if both parents experience migraines.

Other medical conditions have been found to increase the risk of developing migraines, such as anxiety, bipolar disorder, depression, epilepsy, and sleep disorders. Although there is no cure for migraines, treatments focus on relieving symptoms and preventing additional attacks. Nonmedical relief of symptoms include drinking fluids; using a cool compress or ice pack on the back of the neck, forehead, or top of head; and resting with the eyes closed in a cool, dark, quiet area.

In the outpatient setting, misuse of OTC headache agents, such as Excedrin, is frequent and can lead to chronic headache pain due to overuse. If patients are taking OTC pain relievers more than 2 days a week, they should be directed to see a physician, who may prescribe a product to better manage the migraines.

Because each individual’s migraines are different, it stands to reason that not every available medication works in every case. Pharmacists can help patients determine which medications might work for them and educate them about how the medications work and their possible adverse effects.