Pharmacy lead migraine clinics- thoughts ?

For our project we have decided to create a migraine clinic service in local pharmacies where you can sign up and receive regular review and help with your migraine management.

we would love to receive and comments and what you expect in this service. whether you would find it helpful or not.

Thank you

We are pharmacy students and this is part of our final year project. No information you provide would be quoted in our project proposal. We are only posting this to gain perspective of whether our idea would be useful.

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  • Would you be offering diagnostics for people who have yet to be diagnosed? If so, how would that work - eg if someone describes what could be cluster headaches would you advise them as such - or would you refer them to a GP? If someone describes going numb down one side as a symptom, again would you advise them to go to a GP? I can't see how it would work - the risk being it might not be migraine. . .and only a GP should advise, so you would just have to tell them to go to the GP anyway?

    If not offering diagnostics and users would have to go to the GP anyway, what would you offer?

    I don't mean to be negative, but I'm not really sure what you intend to do - perhaps you could provide more details?

    Personally, I had to see my GP many times, go for multiple scans to rule out anything else, get prescriptions for from the GP for some drugs etc Adding an extra step of going to the pharmacist first would just add another layer of frustration and delay getting the proper diagnosis/treatment. I know pharmacists in the UK can give out triptans, so would this just be advising people on the use of over the counter medications+ triptans?

    Are the pharmacists going to be migraine/headache specialists or at least have in depth knowledge on the different types of migraine/headaches?

    Again, not meaning to be negative. . . would jsut like to know what you would be offering and who would be offering it.

  • Thank you for your input. I do understand your worries and concerns. Pharmacist are able to prescribe medications when they qualify as a independent prescriber. Yes we would make sure all pharmacist are competent in the diagnosis of migraines but this service would more be used on the management of migraine treatments. In this instance it could be either self referral to our service or your GP would refer you on to our service or patient identified by pharmacists.

    We would offer you help with your medications as there are many treatment options out there. we would be able to review your medications and you can consult us on any questions you have regarding the condition and how you are doing. Pharmacist are trained for 5 years with good clinical knowledge and would be able to either adjust the treatment them selves or liase with your GP and make sure you receive the best possible treatment.

  • I appreciate the reply and the sentiment, but shouldn't people with long term migraine issues where management is a problem be referred to headache specialists or in hospital clinics, (such as the headache clinic at St.Thomas)?

    I didn't really get anywhere for years and years because multiple GPs just didn't have the level of knowledge required to offer a good service and jsut repeated the old, 'have some triptans', 'fill in a food diary' etc etc, it was only when I went to these types of places I actually got somewhere with treatment...

    With all the misdiagnoses and people (including GPs) unaware that there are actually headache clinics and independent migraine specialists such as the NMC, my worry is that people will end up being put on some medication after going to the pharmacist and never get anywhere...

  • Yes this would definitely be an issue that we will address by ensuring patient and pharmacist establish a good rapport. Participating in this service does not stop patients seeking other help if required. I am aware of the specialist migraine clinics but many patients have said they are good and valuable but waiting time are up to months and locations are only in main cities. Like the national migraine centre we are trying to create a service that is able to provide patients with tailored treatment plans within the community.

  • I understand, waiting times can be an issue. May I ask who you work for or are affiliated with?

  • I am a UCL pharmacy student as part of our final year project we have to create a service.

  • That's really cool! I wish you success as anything which would have sped up finding my correct treatment or helping would have been very much appreciated. If I could offer some constructive criticism/ask some questions.....

    I think you would have to be very careful with the advice/diagnosis side of things as some of the different types of migraines have similar symptoms to some seriously nasty unrelated conditions and you wouldn't want to tell someone they have migraines and prescribe them some pills when they are actually dying. . . this is what I'm struggling with, what would qualify (and cover from a liability sense) pharmacists to advise people on this? A lot of the time with migraines especially the aura and if symptoms change over time, the GP would send you for a brain scan to eliminate anything else going on - how would that work if someone went to a pharmacy based clinic - the pharmacist can't refer to a radiologist/neurologist and when would they advise to goto GP etc?.

    You say it's being set up to help manage and have regular reviews, but if a patient has found something that works, they wouldn't need the service - if something in their condition has changed, then they should probably go back to the GP (as in the above paragraph)

    Perhaps you could get GPs on board more so, and provide an information service which is drawn up with GPs/ headache specialists. You could train the pharmacists to know the (many, many) different types of headaches/migraines and available treatments, but then prepare a report to the GP for the patient to take with them and speed things up immensely? This way the GP can make the judgement call on what needs to be done, but with a pre-filled report asking all the right questions (GPs and headache specialists could choose the report questions and content). Once they have got the initial diagnosis out the way and given a treatment path, then you could follow a plan which is pre-defined and agreed with the GPs/Specialists but in the pharmacy - which would include criteria for advising if they needed referral back to GP/Specialist instead of carrying on the pharmacy service.

    One of the main issues I faced, is that GPs didn't know about half these types of migraine conditions (and why would they, they can't specialise in everything) if I was given an idea years ago of what was actually wrong (cluster headaches) I could have got a better treatment. Work with specialists to make a questionnaire asking the right questions to narrow down the problem and help the GP out in terms of what to do and who to refer to. . . .

    I seem to have talked for ages and I'm sure you have thought of all of it already :p just want you to succeed as it could potentially be a real help for migraine sufferers if done in the right way!

  • I would find that service useful. I am probably more informed about migraine option treatments than my GP & would be just as happy to discuss management options with a pharmacist, particularly if I could just walk in & chat to a pharmacist rather than waiting several weeks for a Drs appointment.

    Would you be able to prescribe preventative meds as well or are you just thinking acute?

  • We are only at the stage of planning so we would welcome any ideas of what you would find useful. Pharmacist who are independent prescribers are able to prescribe preventative medications.

  • I love this idea! It can be a long wait between neurologist appointments. I like the idea of having an expert that is easier and closer at hand to consult. Also, pharmacists are much more familiar with medications, their usage and risks, and more up to date on new treatments, than doctors.

  • I may be completely wrong but your post seems to be commercial in its intent, so I would like to draw your attention to the item in the terms and conditions - copy of which is posted below.

    Whilst I personally don't have a problem with someone trying to make sure that they are doing something that really meets what people want please could you make sure that you have the permission of health unlocked and the relevant forum administrator and that your post is quite clear that this is what you are doing

    The administrator for this forum, Rebecca_NMC is listed on this page

    healthunlocked.com/migraine...

    Apologies if I have mis-interpreted.

    healthunlocked.com/policies...

    5. Non-commercial use by users

    The site is for the use of individuals for non-commercial purposes only. To use information gathered from HealthUnlocked commercially or to reach HealthUnlocked users with commercial interest unless expressly authorized by HealthUnlocked is against these terms.

    If you wish to use the site for commercial purposes related to your role within healthcare provision you may be able to extend your account to include a role (e.g. Health Care Professional (HCP), Patient Organization, Researcher, Provider, etc). In doing so, you may have to comply with extra terms like Terms of Engagement for Affiliates or Terms of Engagement for HCPs.

  • Thank you for pointing this out. we are only pharmacy students. All the comments we received would not be used in any shape or form into our report we are only wanting opinions of migraine patients on a service like this. Of course if this counting towards as "commercial use" I would be happy to extend my account to an appropriate role. But I am unable to find how I can do so. It would be helpful if you can point me to the right direction

  • think you will need to contact health unlock support - link is at the bottom - under support

    would advise that you contact them and the forum administrator and may be edit the actual post itself to make the context a bit clearer - edit is one of the options under the down arrow next to the follow post box.

  • Hi, I think it's a brilliant idea,as we all know GP appts can be hard to get now. I also do use my local pharmacy for mild ailments.

    I think one of the things that would be helpful is advising people of the different food triggers. I cut out the usual suspects & it didn't help, but I've finally found that bananas trigger mine. I used to have one a day,since cutting them out I've only had one attack. For me after 30 years of pain, it's incredible.

    I think it is good idea to question people on the medications they're taking & how often. One thing that isnt understood by laymen are painkiller headaches. I've fallen into that trap, & now know if a migraine has lasted two days or more that on the third day I should just let my body deal with the pain & not taken the medication. It's not fun,but it stops the vicious cycle.

  • Great idea! Let me know if you do it.

  • Hello,

    I agree with tom1984, I've had migraines for over 20 years (I'm 38) It is only in the last 4 years I have actually had correct treatment. GP's have been absolutely useless, often completely insensitive and hugely ill informed. Neurologist have been just as bad, it is only now that I am in a specialised headache clinic at Addenbrookes that I am getting proper treatment. It is only now that all the things I have been saying for twenty years to all the doctors have been explained and discussed where possible. I can't see how a Pharmacy based clinic could possibly hope to deal with the complexities that migraines display. My GP's didn't even seem to know that Triptan use should be restricted to 6 days a month. I have GP's that have told me categorically that migraines always last 48 hours, basic stuff that is completely incorrect. Because of the levels of ignorance I did not get treatment earlier, had this happened my migraines may not of become chronic. If you are just going to go through the list of Triptans and the list of migraine preventatives I suppose a pharmacist could do that as easily as a GP. It would be important to make sure you referred them elsewhere if it is clear these are not working well enough however. It was only Botox that has had any effect on my migraines, before then I had been on all 7 Triptans and at over 8 different preventatives. I had been asking my GP's for Botox for 6 years before I actually was finally given it at the hospital. There are some exciting developments on the horizon for the treatment of migraines but I should think all of them would have to be given from hospital. Sorry about going on and on, its just my life has been hugely affected by a lack of sophistication in the general treatment of migraine. I hope Pharmascies wouldn't underestimate the huge amount of research that would be needed to successfully diagnose. I have been told many times the only reason the doctors could tell I wasn't having a Stroke, Menigitis or a brain tumour was because I would have 'been dead by now' so obviously seeing my medical history was very important, so I presume you would have access to the patients medical history also?