Didactic Migraine Education in US Doctor of Pharmacy Programs

Article excerpt


Among common pain conditions, headache causes the largest decrease in worker productivity in the United States, with a mean productive time loss of 3.5 hours per week. (1) Migraine headache is a chronic illness that affects approximately 30 million adults but remains under diagnosed, misdiagnosed, and less than optimally treated. (2-4) Migraine produces significant individual burdens in terms of pain, emotional distress, and impaired function. (2-5) Direct medical expenses are $2571 higher per person per year than in matched nonmigraine control subjects and cost society an estimated $11 billion annually. (6)

Medication misuse is pervasive among migraine sufferers. Many patients futilely self-treat with nonprescription agents. (2,3,7,8) Rarely effective and potentially harmful drugs such as butalbital-containing products and narcotics are widely prescribed. (9-12) Chronic daily headache affects 2% to 4% of the general population and up to 80% of individuals presenting to specialized headache centers with chronic daily headache are overusing acute agents. (9) Headache is a frequent emergency department presentation, yet migraine therapy within emergency departments is dismal, including lack of diagnosis, dependence on narcotics, low utilization of migraine-specific drugs, and few successful outcomes. (13-17)

Pharmacists are well positioned to advocate for constructive medication changes. Headache ranks among the main reasons people seek a pharmacist's assistance. (7) Among community pharmacists, 85% report making between 1 and 5 nonprescription headache product suggestions daily, 12% make more than 6 recommendations daily, and 80% regard headache sufferers as important to their practice. (18) However, PharmD candidates received only one 60-minute headache lecture and few headache clerkships are available. (19) Furthermore, only 8% ofpharmacists reported using evidence-based approaches to treat headache, while 59% reported being unfamiliar with evidence-based data. (18) Our objective was to compare PharmD candidates' didactic migraine education to the recommendations of the US Headache Consortium's evidence-based migraine treatment guidelines. (20)


The Chicago College of Pharmacy's Internal Review Board approved this project. A cross-sectional, descriptive, self-administered survey instrument was used to collect data, and survey completion was considered participation consent. The study was conducted between July1,2008, and April 30,2009. A census of all 90 ACPE-approved PharmD programs was the target population. (21)

Data was collected via a mailed survey methodology following principles outlined by Dillman. (22) In July 2008, a cover letter, survey form, and postage-paid return envelope were mailed to each programs' department head/ chair of pharmacy practice listed in the American Association of Colleges of Pharmacy's 2007/2008 Roster of Faculty & Professional Staff booklet. We requested that the survey form be forwarded to the faculty member responsible for providing the migraine lecture in their therapeutics course. This faculty member was considered to be the "key informant" for the study.

Beginning in December 2008, each nonresponding program's department head/chair was contacted a second time via e-mail or phone call to identify the key informant. A combination of personal e-mails and phone calls was then used to contact the key informant, send the cover letter and survey instrument, and request that they participate in the study. In April 2009, a final reminder e-mail or phone call was made for any remaining nonrespondents, informing them that the study was coming to a close and again asking them to return a completed survey.

Demographic information was collected to help describe the respondents and categorize findings. Initial versions of the survey instrument were reviewed by 7 University of Minnesota survey research experts, 4 of whom held a license to practice pharmacy in the United States. …