Migraine Medications: Let's Discuss Polypharmacy

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Migraine medications are always a prominent topic for discussions and questions. We often discuss the potential side effects of individual medications, but we don't discuss the impact of polypharmacy.

Polypharmacy is the simultaneous use of multiple medications, and it's the focus of the 2016 Talk About Your Medicines Month (TAYMM), sponsored by the National Council on Patient Information and Education (NCPIE).

Polypharmacy includes all medications — prescription medications, over-the-counter medications, vitamins and other dietary supplements, and "natural" remedies such as herbal remedies. Polypharmacy is quite common in migraine treatment, both acute and preventive treatment. For acute migraine treatment, it's common to use both an abortive medication and symptomatic medications for symptoms (such as nausea) at the same time. For preventive treatment, many migraineurs find that their best results come from a combination of preventive medications.

Even though it's common, polypharmacy can present some concerns:

  • The concurrent use of multiple medications can result in an accumulation of side effects or medication interactions.
  • Patients who have multiple health issues and more than one doctor prescribing for them could face additional challenges.
  • In older patients, there's an additional concern of medication side effect symptoms possibly being confused with normal symptoms of aging and being overlooked. These symptoms can include:
    • anxiety or excitability;
    • confusion;
    • constipation, diarrhea, or incontinence;
    • depression or lack of interest in usual activities;
    • dizziness;
    • falls;
    • tiredness, sleepiness, decreased alertness;
    • tremors;
    • visual or auditory hallucinations (especially confusing in a migraineur as they can also be migraine symptoms);
    • weakness.

To assess our risk for harm caused by polypharmacy, the NCPIE suggests asking ourselves the following nine questions. If the answer to any of them is, "Yes," we should sit down with our doctor or pharmacist for a review of all our medications for possible side effects and drug interactions.

  1. Do you take five or more prescription medicines?
  2. Do you take herbs, vitamins, other dietary supplements, or over-the-counter medicines?
  3. Do you get your prescription filled at more than one pharmacy?
  4. Is more than one doctor prescribing your medicines?
  5. Do you take your medicines more than once a day?
  6. Do you have trouble opening your medicine bottles?
  7. Do you have poor eyesight or hearing?
  8. Do you live alone?
  9. Do you have a hard time remembering to take your medicines?

The NCPIE also offers seven tips for reducing the risks or polypharmacy:

  1. Make a list of every medication you are taking, including its strength and the dose. Be sure this list includes any supplements, vitamins, and over-the-counter medicines you take. For prescription medications, include the name and contact information of the prescriber so that your team of health care professionals can be in touch with each other as needed.
  2. Share your medication list with all of your health care professions at each visit. Ask your doctor or pharmacist to check your list for possible interactions.
  3. Inquire if you still need to take all of the medications on the list, or if you can potentially reduce the dosages.
  4. Always read medicine labels. They may help you avoid a possible drug interaction and to know what potential side effects to be on the lookout for.
  5. Aim to get your prescriptions filled at the same pharmacy, this way the pharmacist has a complete record of all the medications you take and can monitor for possible interactions. Many pharmacies now offer a “medication synchronization” program in which you can coordinate your refill schedules and arrange to pick up of all of your ongoing prescription refills at the pharmacy on a single, convenient day each month and speak with your pharmacist about any issues or questions at that time.
  6. Avoid combination medicines (products that contain multiple active ingredients, like cold remedies that may treat congestion, cough and achiness). Buy only medication that treats the specific symptoms you are experiencing.
  7. If you are already taking multiple medicines, don’t start a new medicine without discussing possible side effects and interactions with your doctor, your pharmacist, or both. If a new medicine is prescribed or recommended, ask “Will this medicine work safely with all of the other medicines I am taking.”

About TAYMM:

Talk About Your Medications Month is sponsored by the National Council on Patient Information and Education (NCPIE). The 2016 event marks the 31st TAYMM event. The NCPIE explains TAYMM:

"TAYMM is an annual opportunity to focus attention on the value that better medicine communication can play in promoting better medicine use and better health outcomes. Initially created by NCPIE and our health education stakeholders as “Talk About Prescriptions Month,” TAYMM has grown and expanded to stimulate conversations between consumers and their healthcare providers about all the types of medicines they may take, with a focus on what to know about a medication in terms of expected health outcomes, possible side effects, benefits and potential risks."

More helpful articles:

11 Tips for Using Migraine Meds Safely

Migraine and Prescription or TOC Acetaminophen Products — Beware

Migraine Medications — Understanding Contraindications and Warnings

Sources:

National Council on Patient Information and Education. "Our 2016 Focus: Polypharmacy — America's Other Drug Problem."