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Migraine in Primary Care

By July 15, 2020Health, Latest, Lifestyle, MAI News

Primary Care is often where most migraine is first presented. It is the most common headache disorder seen by GPs on a day-to-day basis, however, general medical knowledge about migraine is lacking in many cases. The new Sláintecare Towards Self-Care in Headache pilot programme which was announced earlier this year, hopes to combat this. The programme is based on using a multi-disciplinary team of Health Care professionals and an agreed Care Pathway to give Migraineurs a more holistic and hopefully more successful strategy for coping with their migraine. The three lead partners in the programme are the HSE, the Irish Pharmacy Union and MAI.

Sláintecare programme

The programme is made up of the following disciplines:

  • Primary care – Pharmacists, GPs
  • Hospital/Neurological care – Migraine Clinics, Nurses, Neurologists, Physiotherapists, etc
  • Psychological care – Psychotherapists, Psychologists, Counselling
  • Self-care – Self-Management Courses and other supports to help you to manage your migraine on a day-to-day basis.

With many migraineurs not even reaching the hospital or neurologist level, and Primary Care being their main experience in dealing with migraine, it’s important to think about your Pharmacist and GP options.

A high percentage of migraine can be managed very successfully at primary care level and many people can manage so well at this level that they never need to see a specialist. Even some people who do experience chronic migraine can manage well in between visits to specialists with help from their GP or their local pharmacist.

Knowledge is power, and a well-informed GP and Pharmacist can help a well-informed patient take back their lives and gain control over their condition.

This by no means suggests that you should not see a specialist. If migraine can be managed successfully without going to see a specialist then that’s wonderful, but if it requires the help of a specialist then by all means, see a specialist! You need to look after yourself and you deserve the best possible treatment that helps.

The Role of a Pharmacist:

Pharmacies are often the first port of call when people experience their symptoms of migraine.

According to the Irish Pharmacy Union’s Website:

Your pharmacist is a healthcare professional who can assist you with your health concerns quickly. They can offer you information about treatments, explanations on medication interactions and much more. They will also guide you to other health professionals or community services, if required.

Your pharmacist may offer a range of health services, such as blood pressure measurement, cholesterol testing, smoking cessation service and seasonal flu vaccination.

More than just prescription filling

Pharmacists are a front-line service run by Primary Care professionals who practice in almost every town and village in Ireland” says Prof. Martin Henman, Assoc. Prof. in the Practice of Pharmacy in Trinity College Dublin, in Migraine: Not Just Another Headache. “They are easily accessible without an appointment and are ready and able to help and advise you on migraine as well as many other disorders and illnesses.

Your pharmacists can and do much more than just dispense medications. They have four main areas of responsibility:

  • Assisting patients and doctors with the use of their prescribed medications
  • Providing advice and information on the use of non-prescription or over the counter (OTC) medication
  • Assessing and advising about symptoms
  • Health promotion and advice about health and lifestyle on its own, or how it might affect your condition

Your pharmacist will of course dispense your medication and let you know when your prescription runs out.

They may ask you a few questions such as what condition the medication has been prescribed for and they will double check that it is compatible with other medication you may be on.

Don’t take offence as the only information on the prescription is the name of the medication, how much the GP wants you to take and how often they want you to take it. The pharmacist needs to fill in some of the blanks to make sure they can help you and that everything is okay.

Of course, you don’t need a prescription to see a pharmacist, and many migraineurs are lucky enough to be able to manage with OTC medication such as Ibuprofen, Paracetamol and Aspirin. Many pharmacists now also supply herbal remedies, nutritional supplements or other complementary products which may also be useful for migraine sufferers.

Book a consultation

They, like GPs have a lot of knowledge about many medical conditions but cost nothing to see. You can ask to speak to them privately as most pharmacies have private consulting rooms.

The Pharmacist will also be able to talk to you about how medication may affect your day-to-day life.  If your medication requires a few doses at different times of the day, they may be able to help you find ways to schedule them so they’re less disruptive.

They will also explain the importance of following instructions, and being patient, particularly when starting a new medication. Many people expect their medication to work within a few days. When this doesn’t happen, they become discouraged and stop taking them. A pharmacist should be able to give you an idea of when the medication should start to work.

They will also be there for you throughout the course of medication. Speak to your pharmacist about any strange symptoms or issues your experience.

GPs and Pharmacists will, if necessary, refer you on to other medical professionals or specialists. This could be medical support in hospitals, at the migraine clinics, or emotional/psychological support.

The Role of a GP:

According to the Irish College of General Practitioners and their website, the European Definition of General Practitioners is;

General Practitioners/family doctors are specialist physicians trained in the principles of the discipline. They…

  • are personal doctors, primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care irrespective of age, sex and illness.
  • care for individuals in the context of their family, their community and their culture, always respecting the autonomy of their patients.
  • recognise they will also have a professional responsibility to their community.
  • In negotiating management plans with their patients they integrate physical, psychological, social, cultural and existential factors, utilising the knowledge and trust engendered by repeated contacts.
  • General Practitioners/family physicians exercise their professional role by promoting health, preventing disease and providing cure, care, or palliation. This is done either directly or through the services of others according to the health needs and resources available within the community they serve, assisting patients where necessary in accessing these services.
  • They must take the responsibility for developing and maintaining their skills, personal balance and values as a basis for effective and safe health care.”
A Holistic Approach

So, your GP looks at the whole situation, not just the illness or disorder you experience. They…

  • look at you, your history, your family history, etc.
  • consider how you feel aside from being sick, if you have any emotional problems, or an underlying illness.
  • use all that information to make the best decision possible to help you.

You can help your GP by providing details and information that will help them to help you. Planning your visit well can help to bring about the best possible outcome for both you and the GP.

If you’re a GP you can download a copy of the ICGP Migraine QRG 2019 – ICGP Quick Reference Guide for Migraine

Planning your visit:
  • When calling for your appointment, ask if longer than normal visits are available – this way you know that you will have the time to spend with your GP to explain what you’re going through
  • Don’t bring children with you if possible – especially if you’re going to be longer than normal.
  • If you can, bring someone you trust and feel comfortable with, so that you won’t miss any of the details.
  • If this person is a partner or close friend/family member, they may have noticed changes in you at home that you might not be aware of.  Things like mood swings, confusion, clumsiness, etc. can be important information for the GP
  • Tell your GP more than just the painful symptoms. Give them all the information you can. Better still, bring your diary if you have one.

Your GP should be able to diagnose your condition, but primary headache disorders are hidden and have many symptoms. They are often mistaken for sinister or secondary headaches. Most doctors will want to rule these out before proceeding to a diagnosis. A CT scan or MRI will rule them out.

Migraine doesn’t show up on most scans, therefore your scan will more than likely be clear. The doctor should always look at family history of migraine; e.g. Migraine mostly manifests in Children as as upset stomach with vomiting. Travel sickness as a child can indicate migraine.

Migraine Diary

When the doctor does diagnose you with migraine, there are a lot of different options to choose from.

They should begin by asking you to keep a migraine diary. This will help you to track your symptoms, occurrences, and medication. Patterns may appear over time, and the GP will be able to judge the effectiveness of prescribed medication.

This will allow them to decide whether or not to change the dose, or try a different medication or tactic.

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