People with psychiatric conditions are at greater risk of developing migraines, and the reverse is true as well. Treating a patient with migraines is more difficult when the person also has a psychiatric illness.
But pharmacists have the expertise to help manage both of these conditions.
However, treating them presents unique challenges and problems. When it comes to handling migraines in psychiatric patients, both compliance and adherence are big issues. That’s because psychiatric patients are more likely to overuse or underuse a prescribed medication.
Doing either can have harmful consequences. For example, taking an NSAID or triptan more often than prescribed or more frequently can actually cause migraines. There is a name for this condition – medication overuse headache.
But underuse of medication can cause its own kind of problems. Often, migraine medication therapy takes 4 to 12 weeks to improve symptoms. But many patients stop taking the medication before then because they see no effect.
Lack of adherence to drug regimens can lead to a prescription cascade. The symptoms, which recur because the patient is not taking the drug, are attributed to other causes, leading to more prescriptions, possible side effects, and harmful drug interactions.
Pharmacists need to be careful when recommending medication therapy for migraines because psychiatric patients often take other drugs, and interactions among them can be a potential problem.
Recommended drugs for treating migraines and other comorbidities with psychiatric patients:
Venlafaxine – treats migraines and PTSD
Nortriptyline – treats insomnia and depression as well as migraines.
Drugs not recommended:
Beta-blockers and verapamil, a calcium channel blocker – can make symptoms of depression worse.
SNRIs – not for people with bipolar disorder because they can cause hypomanic episodes.
Medications that cause serotonergic effects should be used cautiously or not at all in patients with migraines.
How Pharmacists Can Help
Psychiatric patients sometimes have difficulty remembering their medication history. Because pharmacists have access to prescription records, they can inform other healthcare professionals of potential problems, such as drug interactions, that they may not be aware of.
Pharmacists can help psychiatric patients to spot signs of adverse side effects and explain the importance of adherence.
Pharmacists are in a good position to assess patients’ progress because they interact with them more often than other healthcare professionals.
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