Migraine Toolkit Helps Community Pharmacists Spot Disease Early

Community pharmacists are on the front lines of identifying patients whose headache may actually be an undiagnosed migraine, thanks to a new streamlined screening toolkit designed for busy pharmacy counters. This becomes especially important to close the gap for racially diverse patients.

“Time is definitely very tight,” said Ogechi Ubanyionwu, PharmD, BCACP, a clinical pharmacy specialist of ambulatory care at Harris Health System, explaining why the resource was built around just three core questions. “There are 3 questions. One: ‘Has headache limited to your activities for a day or a month in the past 3 months.’ Second question is: ‘Are you nauseated or sick to your stomach when you have a headache?’ Third question being: ‘Does light bother you when you have a headache?’”

According to Ubanyionwu, even a single “yes” opens the door for meaningful intervention. “One or more yes to these questions does provide an opportunity for community pharmacists to at least make a recommendation for over-the-counter medication options,” she said.

But the tool is also designed to flag likely migraine. “If we’ve identified that the patient or the individual has 2 or more yes, then this at least gives us an opportunity to identify migraine disease with higher accuracy,” she said.

The goal is not diagnosis—that remains the role of physicians—but navigation. “As you know, pharmacists, we do not have the ability to diagnose anyone, but we do have the opportunity to provide a resource to the patient to make that referral for them to see their primary care provider,” Ubanyionwu said. With frequent, informal encounters at the counter, pharmacists are uniquely positioned to spot patterns and start conversations that might not happen in the exam room.

That reality shaped the toolkit’s design. Ubanyionwu noted, “We try to make it as quick and short and easy to understand as possible. Again, this was designed with the community pharmacist in mind, who has very limited time sometimes with the patient in the count within the counter.” At a minimum, she added, “This is sufficient enough for them to use at least in the community setting.”

Already, there are real-world results. Ubanyionwu shared the experience of a colleague who codeveloped the tool and owns a pharmacy. “He was actually able to use the toolkit in identifying an individual who’s already living with the migraine disease, and he was able to identify that the patient needed to follow up with their primary care provider, and he was also able to identify the need for this patient to get their refills on their medication,” she said.

The initiative also seeks to push back against dangerous misconceptions. Ubanyionwu called out “a common misconception not only among pharmacists but individuals in general, and that it is just a headache, right? And that they’ll go away with time, or that the patient can just push through it and they’ll get through the symptoms.”

In reality, she warned, “untreated migraine disease worsens over time, and it can also progress to chronic migraines,” and “being able to identify the symptoms early and make these interventions early does matter.”

Ubanyionwu urged pharmacists to “make sure that you’re going on to our website npha.net/migraine to check out the toolkit and any additional resources surrounding migraine disease.”

She described it as a “very useful toolkit. Very quick, short, and simple,” and emphasized its role “especially in recognizing and addressing inequities in migraine care.”