Treatment of migraine: a review of disease burden and an update on the therapeutic landscape for pharmacists

Abstract

Given the key role of pharmacists as a healthcare resource for patients seeking treatment of headache associated with migraine, this review highlights the burden of migraine, recent advances in preventive migraine therapies, and key takeaways from the most recent migraine management consensus statement. For at least two decades, it has been understood that correct diagnosis of migraine is key to its effective management. Migraine attacks should be treated promptly with acute medications, with preventive treatment for patients with regular, frequent, and/or disabling migraine attacks. Nonetheless, most patients with migraine are still not correctly diagnosed, and do not receive appropriate therapy for acute or preventive treatment of their disease. In addition, patients may be refractory to or unable to tolerate traditional oral preventive treatments, leading to underutilization of preventive treatment and subsequent reliance on acute treatment. Overuse of acute medications is associated with increased risk of progression from episodic to chronic migraine and development of medication overuse headache; therefore, pharmacists should counsel patients receiving over-the-counter or prescription acute migraine medications on when to seek options for preventive treatment to help avoid medication overuse. Pharmacists are well-positioned to identify those patients who would benefit from physician referral for further assessment and treatment with preventive therapy. They also have an important role in educating patients on the benefits of preventive medications, and realistic expectations of treatment outcomes.