Picture your busy day at the community pharmacy. The phones are ringing off the hook, prescription orders are coming in fast and furious, the mountain of unchecked prescriptions keeps rising and then you are asked an over-the-counter question about headaches.
Your patient LS is a 23-year-old female, complaining of a headache that has not improved for the past two days. She typically gets headaches around her menses and sometimes due to lack of sleep. Her normal “cocktail” of Tylenol and Advil usually knocks down the pain level just enough for her to power through the day. She reserves Gravol only for when she feels extremely nauseated because she does not like the groggy side effect. How would you proceed in this case? How would you assess and make recommendations? What if LS had headaches on a regular basis? When would you refer this patient?
For many pharmacists, answering these questions efficiently can be a daunting task, especially without a lot of knowledge about headache disorders. I can remember having only a handful of hours dedicated to learning about headache disorders like migraines in pharmacy school. The education definitely was not enough to assess and optimize therapy for people affected by migraine. Now, four years into practising as a community pharmacist, I’m still learning about this complex disorder to try and help patients, like LS, with my migraine consultation service.
Migraine is one of the most common chronic disorders, affecting 14.7% of the global population. Migraine can be debilitating, and it is estimated to lead to seven million workdays lost annually in Canada. Despite these staggering numbers, there is a lack of awareness and knowledge that results in many patients being undertreated. Furthermore, many patients have poor access to appropriate migraine care (example: patients do not have access to a family doctor or patients are on a long waitlist to be seen by a headache specialist), and as a result, they continue to suffer from poor migraine management.
Unlike migraines, other chronic disease like diabetes, asthma and COPD, have many resources and educational certification programs available for healthcare professionals. This motivated me to reach out to Migraine Canada and collaborate with headache experts to create an educational course for pharmacists across Canada.
Migraine Canada is a federally registered charity in Canada founded in 2018 by leading neurologist Dr. Elizabeth Leroux. Since this time, the charity has made great strides to continue accelerating growth and increasing capabilities as Canada's national patient organization to fulfill the mission and vision in supporting the community. Migraine Canada believes that pharmacists are key stakeholders in their organization because of the large number of patients with whom pharmacists interact who are living with migraine and undiagnosed headache conditions. Migraine Canada recognizes that most pharmacy schools across Canada include limited training and collaborative opportunities in their programs. As such, a strategic priority of the organization is to work with professional pharmacy associations to provide more opportunities for pharmacists to learn more about migraine. This led to the Canadian Headache Society developing the first ever migraine educational course for pharmacists, called “Migraine Management Mastermind for Pharmacists,” which is available to all pharmacists in Canada at no cost.
Migraine Management Mastermind for Pharmacists is an accredited course. It includes four interactive modules that will help improve pharmacists’ knowledge about migraine and assist them in developing individualized treatment plans for their patients to improve migraine-related outcomes. In Module 1, pharmacists can expect to gain a better understanding of the diagnostic approach to migraine as well as applying the elements of care plans and approach to counselling patients with migraine. Module 2 is designed to improve knowledge of acute treatments for migraine and an approach to medication overuse headaches. In Module 3, pharmacists will gain valuable information about migraine preventives and when to consider preventives for their patients. In the last module, pharmacists will learn about managing menstrual migraines, use of contraception for women with migraine with aura, and approach to managing migraine in menopause.
The scope of practice and consequently the role of pharmacists are changing across Canada. Utilizing pharmacists in managing chronic disease will be key in improving patient outcomes. As such, I strongly urge all pharmacists to consider specializing in chronic disease management, and especially in migraine care. There is still a giant gap in care for patients affected by migraine. The Migraine Management Mastermind for pharmacists' course is a big step in the right direction to help address the gap in migraine care. You will improve your knowledge about migraine care, you will be able to provide tailored treatment plans for your patients affected by migraine. And this new knowledge will give you an edge and help you distinguish yourself from others while helping your community. I urge you to visit Migraine Canada’s website and review other available resources and tools and even sign the petition to improve migraine care for Canadians.
Dr. Fairuz Siraj, PharmD RPh, CDE, is a specialty pharmacist at Pharmasave Victoria BC