TRANSCRIPT:

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Voice-over: Welcome to Spotlight on Migraine, hosted by the Association of Migraine Disorders. Join us for fresh perspectives by medical experts and advocates as we explore the spectrum of migraine and dig deeper into this complex disease.

This episode is brought to you by our generous sponsor, Lundbeck.

Molly O’Brien: Hello and welcome to Spotlight on Migraine. I’m your host Molly O’Brien. Today’s topic, we’re talking all about the role of a pharmacist in migraine care, and to do so, I’d like to welcome our guest. She’s a pharmacist and the founder of the Migraine Pharmacist, Heba Hani. So good to see you this morning.

Heba Hani: Hi, how are you, Molly? Thank you for inviting me.

Molly: I’m so good, and we’re so excited to have this chat with you today. You have worked around the world, you’ve launched a ton of amazing products, and your focus really is on the migraine patient. So we’re looking forward to getting a lot of insight from you today.

Heba: Thank you very much. Thanks for inviting me.

Molly: So a pharmacist can play a big role in migraine care, but they’re often underutilized. Can you tell us just a little bit about how a pharmacist might be able to help a patient with their migraine care and treat their symptoms?

Heba: Pharmacists are underutilized possibly for a number of reasons. Migraine, specifically, is not as focused — or, healthcare systems are not focusing on migraine as they should be. And, of course, that means that not everybody is involved in migraine care. Migraine is a primary healthcare issue, and it needs to actually be addressed at the primary healthcare level. That includes pharmacists, nurse practitioners, family doctors.

We don’t have enough neurologists to actually tend to all these migraine patients. There are more migraine patients in North America than there are diabetes patients, and if we are expecting that all of them should be at the neurologist being managed, at the neurologist clinic, then we are actually depriving a lot of patients from the care that we can provide. 

Pharmacists are educated, they are knowledgeable, they are keen to help patients, and we see them. We see the patients much more than any other healthcare provider. So, yes, there is an underutilized sales force or, let’s say, a care force that you can go and you can approach these patients and get the maximum care and the best care that you can give for them using unutilized healthcare professionals.

Molly: And what kind of education can a pharmacist provide patients or people who might not even know they have migraine?

Heba: So, to start with, the first point of contact that a pharmacist has with a patient is when the patient comes and looks for a headache medication. They would go, usually, they either get acetaminophen or they get ibuprofen, and they go home. And sometimes it works; sometimes it doesn’t work. They come back. They might or might not ask a pharmacist. And what we would like is for each and every person who does have a headache to approach the pharmacist and check with them — check in, ask, “What is the best medication that I can have? What is the best formulation?” 

And that will open the door to the pharmacist to actually identify these patients, because migraine is not a simple headache and a lot of our patients go undiagnosed. They are not even identified as migraine patients. They have it for years before someone comes in and says, “Hey, that’s migraine.” And sometimes that’s a little bit too far and too late for them to get the care and to prevent them from going from episodic migraine into chronic migraine. Pharmacists are the first line of defense. When they go to the pharmacy to get a medication, that’s when we can intervene. That’s when we can counsel, we can ask. 

And most importantly is pharmacists are equipped to identify red flags. If someone is coming with a headache that looks like a sinister headache, a headache that needs attention, medical attention, immediate attention, pharmacists are able to do this for them. And this is really important, and that’s why we do encourage patients, when they go in to get painkillers for their headache, to actually talk to the pharmacist. 

Another point of contact that we have with patients is when they come for the first time with an acute prescription medication like a triptan or even an NSAID that is actually prescribed. And this is a great opportunity for us to talk to the patient, educate, tell them what to expect, how to use the medication. 

Without even thinking, we look at what else are they taking. We look at their history. We look at what their personalities are. Some patients want encouragement; some want very clear instructions. We are able to spend the time to educate, to counsel, and also to follow up. 

So if it’s a patient who has just gotten this medication, we can follow up with them. And it’s part of what we do. We do call after a few days, say, “How are you doing? How is your headache? Are you feeling better?” We also tell them what side effects to expect and what is not expected, what would be a sign that you’re not doing well, you’re getting worse, you need to seek medical help. So this is where we are in terms of what pharmacists can do at the pharmacy.

Last but not least is prevention. A lot of our patients have reached the point where they need prevention. Their quality of life is actually interrupted; they’re not able to lead good quality of life.

So a pharmacist can look at what preventative measures or what preventative medications can be recommended. 

And we do communicate with healthcare providers. We do communicate with the GP or the family doctor that the patient is seeing and even the neurologists. They don’t see their doctors as often as they see us, so we can actually be the cheerleaders: “Go on, take your medication.” But we can also be the ones that say, “Hey, they’re not doing well, so, please, we need to intervene,” and we need to find more ways to help and better ways to manage and help these patients.

What we do is we send the request for the prescription, and we get it faster than the patient calling for an appointment. We send the request. We do contact the doctor and say, “This patient needs an antiemetic, and this is my recommendation, this is the dose, this is the frequency. Can I get a prescription?” And they send it, and we get it within hours from us sending that fax. And the patient can follow up with the doctor, saying, “My pharmacist requested a medication. Has it been sent?” And that is where you can, instead of them having to wait — I mean, I’m not sure what the wait times are in the States at this point of time, but in Canada, the wait times are ridiculous.

So, instead, we shorten that time, and because we are healthcare advocating for the patient, the doctor is more comfortable in doing it than the patient saying, “I want another pain medication,” or, “I want something else.” There is still also a stigma. Patients are scared to talk to the doctors. They are worried. They don’t want to be kicked out. If the doctor thinks that they’re using Dr. Google or they’re going somewhere else, they might be penalized.

That doesn’t happen with the pharmacist. The doctor accepts the recommendation from the pharmacist because we are able to communicate immediately, and we get faster response because it’s coming from another healthcare provider. 

This is in a nutshell. There’s much more that a pharmacist can do, but it’s really important that we do have pharmacists involved in patient care for migraine patients.

Molly: You mentioned a couple points there that I kind of want to go back over. First of all, you used the word sinister to describe migraine. And I don’t know if I’ve heard anybody use that word before, and it’s so on point that I’m going to steal it from you. I’m going to use that as an adjective from now on because I love that. It’s such an accurate description.

Heba: We use red flags in pharmacy. We say, “Identify red flags.” But “sinister,” that’s one that we tell them, “No, no, no, that’s not just a headache. That’s not just a migraine. This is the time for you to go to emerg, or if you can get to your doctor immediately, fine, but if not, go to emerg. 

And, as a pharmacist, I’ve done it more than once where I’ve sent patients to emerg because they were having a stroke and they thought it was something else. And they were thinking, “No, it’s OK. I’m fine. I just need something. I just have a headache.” And a mini-stroke that they couldn’t even notice — but then we asked them the questions and were able to send them to get the care that they really need.

Molly: You made another great point, too, that pharmacists are usually seeing a person come into the pharmacy or a migraine patient more so than the actual treating doctor. So do you think it’s important to kind of change our mindset that our pharmacist is part of our healthcare team, so we can strike up conversations and get to know them better, and they can get to know us better — to consider our pharmacists as our healthcare team?

Heba: I think that’s really, really important. In Northern America, everybody lives within 20 minutes from a pharmacy. In the cities, that’s walking distance. So 20 minutes you can get to a pharmacy. In rural areas, you can drive 20 minutes, and that’s the majority of patients. That means that you’re really, really close to someone who knows you, who knows medications, who knows medical conditions. And we need you to get there and start talking to your pharmacist. 

The pharmacist is the only — and that really still boggles me every time I say it — is the only healthcare provider you can see without actually asking for an appointment. You can just walk in and see your pharmacist and ask them whatever you want. And I’ve never, ever turned a patient away, and I’ve never seen a pharmacist ever turn a patient away when they come and they ask for help. 

So go ahead. If you’re a migraine pharmacist, please welcome them. If you’re a migraine patient, please go and talk to your pharmacist.

Molly: And so we talked a little bit before about how pharmacists can be underutilized resources within the community and within the migraine community, and then just for people who don’t necessarily know that they might have migraine. How do you think we can change that? Is it just about the mindset? Is it about opening dialogue? How do we change this so that more people are accessing the knowledge that pharmacists have?

Heba: I think it’s multitiered; I think it’s not just one thing you can do. But as with every change, there needs to be education. Every time you need to change something, you need to start by educating people. You need to educate pharmacists a little bit more. We need to show them what migraine looks like a little bit more, highlight it, educate them, show them what the treatment guidelines are, familiarize them a little bit more about migraine

And that’s what we do. What we do is we go to pharmacists, we upgrade their knowledge, and guess what? They start to see more migraine patients. These migraine patients existed before we trained them, but they become visible. They become a little bit more clear.

When they ask a question, if you have already in your head, you know exactly what the guidelines say. You know that more than 15 you are chronic; you need to get treated as a chronic migraine patient. Or if you go and you see someone who is throwing up all the time, but they are getting a triptan, but nobody has prescribed an antiemetic, then suddenly you start thinking, “Where’s the antiemetic? Why aren’t you on an antiemetic?” You see the patient, but you also start to have a stepwise approach to how you’re going to manage them and how you’re going to support them. 

So you start with the pharmacist, and then there’s also that part that I’m hoping that we reach patients today, that they can go and approach their pharmacist and say, “I need help,” and work together. Pharmacists also work with you. They don’t tell you what to do. They usually are a little bit more collaborative in terms of how we manage patients.

We want to work with you. We want to see you get better. We know you, we know your family, we know your friends, we know where you live, we know a lot about you, and we want to be also your partners in the journey to actually have a better life. 

So, patients, there’s also other healthcare providers. In Canada, we have a migraine pharmacist network. That is a program that is a pilot in Ontario. And healthcare providers, we started actually interviewing patients, providing them with this program, and then contacting doctors with a finding, with a medical history, and what we recommend for their care. And now we’re getting more doctors referring patients to us. 

So the doctors do not have the time. They do not have an hour to actually sit with a patient, explain to them what lifestyle changes need to be made, how to take your medication. They don’t have that time. And we do understand that, especially now with the pandemic, this has become even more apparent than it did before. 

Migraine patients, unfortunately, are more stressed, which means they are getting more migraine attacks because of the extra stress. That’s a trigger by itself. But, also, they do not have as much access to their healthcare providers as they did before.

If someone is in excruciating pain, they don’t want to go to emerg anymore. They do not want to. They are actually really disabled by this condition even more than they did before the pandemic. So if you have someone who can champion this and step up and help patients, I can’t see why healthcare systems will not take full advantage of this.

Molly: And I think part of it is the education, part of it is the healthcare system, but part of it can be on the patient as well or the person who has headache or migraine symptoms. How can a patient approach the pharmacist to either ask questions or to get the conversation going, or is there any strategies you can see so we can get more people living with migraine to utilize a pharmacist?

Heba: Molly, the pharmacist, again, is the only one you can just walk up to and say, “Can you help me?” and they would. And, one more thing, at no charge. We don’t charge you for this. So why would you miss out on the opportunity to talk to someone who’s educated, who has the knowledge, and who’s willing to help you? 

We’ve had one patient actually go to Twitter and say, “For 15 years, I’ve been seeing specialists and my family doctor and all sorts of healthcare providers. Sitting with my pharmacist for the first time in 15 years, I felt heard.” Why would you miss out on the opportunity to be heard? 

If I was a patient, I would just walk in there. If you don’t want to walk in there — I still have patients now, because of COVID, they don’t want to leave the house. I do encourage you to call the pharmacist. We do have now telehealth. You can actually have a Zoom call, similar to what we’re doing now. And that’s what we’re doing with the program.

We do consults now using Zoom. You can talk to the pharmacist. If they have the time, they will do it immediately. If not, they will book you an appointment, and you don’t have to wait six months or eight months to talk to your pharmacist. You can just walk in there, and they will never turn you away. They will always welcome you and try to help you.

Molly: So I feel like it’s so important for people out there with headache or with migraine to know that this is one more tool in the toolbox that maybe we just haven’t thought of before or haven’t utilized enough. So we really appreciate it. 

Well, that wraps up this episode of Spotlight on Migraine. I’d like to thank our guest today. She’s a pharmacist and founder of the Migraine Pharmacist, Heba Hani. Thanks so much for being with us today.

Heba: Thank you very much, Molly. Again, thank you for inviting me, and I’m really, really happy that I got to talk about pharmacists and the role of pharmacists in migraine management. Thank you very much.

Molly: I’m so glad that you joined us as well. I know I learned a ton, and I know that our viewers and listeners out there learned a ton as well. And, hopefully, we can start getting migraine patients and people out there with headache more access to a pharmacist, because the access is undeniable. So we really appreciate your time.

Heba: Thank you very much. Have a very good day.

Molly: And thanks everyone for watching this episode of Spotlight on Migraine. I’m your host, Molly O’Brien, with the Association of Migraine Disorders. We’ll see you next time.

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Voice-over: Thank you for tuning in to Spotlight on Migraine. For more information on migraine disease, please visit MigraineDisorders.org.

*The contents of this podcast are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The speaker does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.