Mark Percifield, PharmD: Amy, what is your advice to community pharmacists to better serve migraineurs?
Amy R. Dunleavy, PharmD: One of the tools that we use in my practice [Osterhaus Pharmacy] is a migraine or headache diary. We often make these available to individuals when someone comes to see a referral because they have noticed an increase in headache frequency or have migraines. We also make them available to people who are receiving preventive therapy from us or who have abortive therapy on their prescription profile. Things that the person should look for and document in this headache diary are things that occur when this headache occurs. You stick the date there. What activities did you do before the headache stopped? What kinds of foods or other things were consumed before the headache stopped? Then they give us a description of what that pain feels like, so let us know – is it throbbing? Is it one sided? Is it bilateral? They also give it a pain ranking.
These are good for us. They allow us to continue this conversation with the patient and help him to recognize when it is time to see a neurologist or see an emergency doctor or his / her family doctor. We also tend to use these to gauge how well the therapies they use are working. Since we are starting a patient with preventive therapy, we like to use this headache diary to assess their case. Do you see the 50% reduction we are hoping for? Do you see a reduction in headaches? This is what we use most often on my website. I have discussed this with other pharmacists and practitioners and it is something we see on other websites as well.
Mark Percifield, PharmD: Timothy, what do you recommend to patients to prevent these migraines?
Timothy Smith, MD, RPh, FACP, AQH: It is important to understand that the migraine brain is an excitable or a sensitized brain. It is a vigilant central nervous system that is very aware of its surroundings and that reacts to things that happen to it in the environment. This is where these migraines result. What patients need to do is try to focus on good health practices. You need to stay well hydrated. You need to get enough rest. You need to adopt good health habits, such as good, healthy nutrition. Everything your mom told you is good for your health – it turns out to be good for migraine prevention. If patients can prevent this by adopting these good health habits, their brains will be healthier and less likely to experience these attacks of pain and other symptoms we call migraines.
If they can then identify some of the triggering events in their life, such as changes in weather – heat or humidity – loud noises, unpleasant smells, certain foods, or alcohol – we can better help. Stress is a big issue. Many women experience hormone fluctuations. Some of these things may not necessarily be avoided, but you can try other ways to compensate by trying to be as healthy as possible and reducing your exposure to potential triggering events. If you can avoid these, you may be able to prevent migraines altogether and not need as many medications to get through the month. It is good to understand that the migraine brain is different and patients have not done it so that it may even be hereditary to be prone to these headache episodes. Trying to compensate for their lifestyle can be of great benefit to patients with migraines.
Mark Percifield, PharmD: Excellent. Thank you very much. I’m telling you – Jennifer, Amy, and Timothy, you have a wealth of knowledge when it comes to migraine information. Many Thanks. I really enjoyed this discussion today, and we hope you found this Pharmacy Times® Peer Exchange rich and informative to our viewing audience. Thank you and have a wonderful day.
Transcript edited for clarity.