Expert Insights from Heba Hani: How your pharmacist can help you with your migraine treatment

0:00 and thank you for the nice introduction
0:02 and thank you everybody for being here
0:03 tonight
0:04 um if you attended our first webinar and
0:07 you came back thank you if this is the
0:08 first time again thank you i
0:11 we are overwhelmed by
0:13 um the nice emails that we’ve received
0:16 um
0:17 asking how you can help in making this
0:20 event known to others so thank you very
0:21 much for being here um
0:24 obviously today what i will try to do is
0:27 just explain how pharmacists your
0:30 pharmacist or pharmacist in general can
0:32 help migraine and my people living with
0:34 migraine
0:41 so
0:42 i guess if you’re here you know that
0:43 migraine is not um something that is
0:47 rare or that is um small in the
0:49 community it
0:51 it it runs in families and it runs in
0:54 men it it’s in men in women in children
0:57 interestingly enough when
0:59 we are in childhood when we have
1:01 children 10
1:03 of boys and girls do get migraine
1:05 um as soon as they had hit puberty only
1:08 eight percent of men continue
1:11 to have my grain or have my grain and 25
1:14 percent
1:15 one in every four women uh do end up
1:18 with migraine it’s a it’s it’s not a
1:20 headache it’s not just a headache even
1:22 though we know that this is how it’s
1:25 referred to as just a headache it’s not
1:26 it’s not a big deal and people do it
1:28 usually to get out of
1:30 responsibility or whatever as we see in
1:32 the media um migraine is a
1:35 has always been underestimated
1:38 historically under-diagnosed and
1:40 definitely under-treated if it cannot be
1:42 seen if it cannot be taken seriously
1:44 then definitely the solutions are not
1:47 going to be addressing the need that
1:49 exists today with people
1:51 for people living with migraine
1:54 pharmacists are very often approached by
1:57 patients
1:58 they
1:59 patients in general request assistance
2:01 with you choosing a headache medicine
2:04 they also talk to the pharmacist about
2:07 side effects they talk to the pharmacist
2:09 about
2:10 what to expect or
2:13 when they prescribe that medication they
2:14 want to know more about it that’s
2:16 usually who they go to pharmacists can
2:19 not only advise you on on
2:22 medications but also they can
2:25 advise you on the type of headache a lot
2:27 of our patients have or more than one
2:29 type of headache and
2:31 then it becomes a little bit more
2:33 challenging for them how to manage each
2:35 and every one and how to identify
2:38 warning signs or
2:41 when things need to be addressed
2:43 differently and this is where
2:45 pharmacists can actually provide help
2:49 so um
2:51 to to make it a little bit easier we
2:55 we will put them in four ways that your
2:57 pharmacist can help you
2:59 um manage your migraine number one and
3:02 most important is medication reviews
3:04 medication reviews are available at no
3:06 charge all over canada to anybody who’s
3:09 on a chronic medication two
3:11 chronic medications and one over the
3:13 count do qualify in ontario i know in
3:16 other provinces the number might go up
3:19 but medication reviews are very
3:21 important they are a great way for
3:24 you and your pharmacist to identify any
3:27 problem areas and
3:29 opportunities for treatment for you and
3:31 condense this information
3:34 in a way that both you
3:36 and your family doctor or your health
3:39 care provider can understand and also
3:42 identify actions needed and make
3:45 recommendations that you can share with
3:47 your family doctor so the first thing
3:49 you can ask your pharmacist is
3:52 approach your pharmacist today and ask
3:54 for a medication review let them go sit
3:57 have a discussion with you
3:59 go over your medications not only those
4:01 that are prescribed but also those that
4:02 are over the counter um obviously if
4:05 if you have one or two
4:08 the the issues that arise are totally
4:10 different if you have more than one
4:12 condition and the pharmacist your
4:14 pharmacist is very well suited to
4:16 actually identify these issues
4:19 the second way that a pharmacist can
4:21 help you is um
4:23 acute medication intervention whether it
4:26 is for
4:27 over-the-counter acute medication so we
4:29 know that um
4:31 most of our patients or most of people
4:33 living with migraine do end up going and
4:36 and getting their acute medication over
4:39 the counter um other than triptans
4:42 nsaids are available over the counter
4:45 acetaminophen is over the count
4:48 a lot of these medications are not
4:50 visible to prescribers and
4:54 get ignored as part of the care plan and
4:57 your pharmacist can help you um
5:00 best
5:03 best mix mix them add them to the mix of
5:06 medications and when to use them and
5:08 what combination you can do and when to
5:10 use them
5:12 pharmacists can also intervene to
5:15 prevent medication overuse headache and
5:18 optimize the combinations that you can
5:20 take to make sure that you get the best
5:22 results
5:24 we always hear from our
5:27 patients that
5:28 nobody takes care of nausea and that is
5:30 something that is very common and the
5:32 doctor
5:34 counts on them getting gravel or getting
5:36 ginger gravel over the counter but
5:38 sometimes it’s so bad and it’s so severe
5:40 that it interfe interferes with the
5:42 quality of life and of how your acute
5:45 medication works because if you feel
5:47 like you want to throw up if your
5:49 digestive tract is going upward and
5:50 you’re taking a tablet and you throw it
5:52 up it’s not going to work so there are
5:55 different combinations that your
5:56 pharmacist can help you to get the
5:59 maximum out of your acute medication and
6:01 to get the maximum relief that you need
6:04 to get from these medications
6:07 third is prevention and in prevention
6:10 from all our patients we find the
6:12 biggest value that
6:14 they
6:16 they get from us
6:18 it comes from the knowledge and from
6:20 um the education that we provide because
6:23 um most of of of our patients who come
6:26 and approach us and ask for advice come
6:28 and say well i’ve tried everything and
6:31 then when we go through the lists and
6:33 when we go through what the options are
6:35 they find out that well there’s still a
6:37 lot that they can try um
6:40 and it validates when when something
6:43 didn’t work they think oh nothing else
6:44 is going to work it validates
6:47 their concerns and and what they
6:50 experienced that you know this this is a
6:52 common side effect the most of the um
6:55 preventative medications that are
6:57 currently still available in canada most
6:59 of them are were designed for other
7:01 medical conditions whether um
7:03 antidepressants anti-seizure
7:06 blood pressure medications which means
7:08 that the side effects are sometimes very
7:11 hard for people living with migraine to
7:14 deal with so it’s very important that we
7:17 have knowledge and we have we look at
7:20 options and see what the value of
7:22 prevention is for you
7:26 again when do you prevent is another
7:28 very important question that sometimes
7:30 is not discussed with your family doctor
7:34 and having the time to talk with your
7:36 pharmacist to ask them so okay is it
7:38 time for me to prevent sometimes
7:42 i hear from my patients
7:44 that sometimes they feel oh i only get
7:47 10 to 14 days
7:49 uh a month so
7:51 it’s okay
7:53 or even if it’s only eight uh even if
7:56 it’s only four it depends on how
7:58 debilitating they are how much they
8:00 affect your life and this is something
8:01 that you can discuss with your
8:03 pharmacist
8:04 um the other thing that that is very
8:06 important with prevention is the new
8:08 medications that are breakthrough
8:12 medications that are now available in
8:14 canada for prevention um cgrp antibodies
8:19 uh we’re having we’re having more and
8:21 more uh you know
8:24 and and it’s it’s just amazing these are
8:26 the first
8:27 medications that are targeted they work
8:29 specifically on these receptors and that
8:33 means that the side effect profile is
8:34 much better than the others that were
8:37 there before and also the ones that are
8:39 coming we’re so excited about all the
8:41 new medications that are uh going to be
8:44 targeted medications that will work
8:46 specifically on the condition that um
8:49 you’re suffering from and not
8:51 for something else and let’s see if that
8:53 works for you and if you can tolerate it
8:57 um lifestyle management that’s although
9:00 i put this as the last but
9:02 interestingly enough we find that
9:06 having someone to go through all the
9:08 lifestyle changes that
9:11 migraine stuff or people who live with
9:13 my might they need to to make to
9:16 reduce the threshold they have for
9:18 migraine or the migraine threshold
9:20 theory is
9:21 you know it’s it’s like a a bucket that
9:24 you’re filling and every time you do
9:28 something or something happens it keeps
9:30 on getting closer to filling and for you
9:32 to have a migraine and by reducing that
9:35 level and controlling all the other
9:37 things within your control because by
9:39 the end of the day not everything is
9:41 under your control but there are a lot
9:43 of um
9:45 lifestyle management techniques and and
9:48 solutions that we know from research
9:51 work and we are very happy to work with
9:53 you and uh and provide you with a list
9:56 and identify your triggers with you and
9:58 work with you on how you can manage it
10:01 manage these triggers and how
10:03 we
10:04 um we can
10:05 be creative about things like um
10:09 let’s say
10:10 we’re going to talk about lifestyle but
10:12 let’s see it’s something as easy as am i
10:14 hydrated am i not hydrated how much
10:17 hydration is hydration and
10:20 how are you going to
10:22 be encouraged to get well hydrated even
10:24 though you know you need to drink lots
10:26 of water especially when you feel an
10:29 attack coming but
10:30 it’s just a habit and how can we work
10:32 with you to have strategies to
10:35 um increase something like that exercise
10:38 diet uh sleep uh keeping a headache
10:42 diary all of this we’re going to talk
10:43 about in details when we get to uh the
10:46 part on lifestyle management so
10:49 in in in
10:52 in summary
10:53 um
10:54 what you should get out from a consult
10:57 with a migraine pharmacist number one a
11:00 detailed treatment plan based on a
11:02 medication review that you will be able
11:04 to share with your family doctor or the
11:06 pharmacist can actually fax it or send
11:08 it to your family doctor so that you and
11:11 your doctor are on the same page and
11:13 that will get the endorsement of the
11:15 doctor the doctor might have a different
11:18 view but at least that will bring the
11:20 conversation uh forward so that you can
11:23 have that conversation
11:25 thinking these are the options this is
11:27 what me and the pharmacist have talked
11:29 but let’s talk further if the doctor
11:32 agrees usually they give the
11:33 prescription and the pharmacist
11:35 continues and does the follow up with
11:36 you and make sure that the communication
11:39 is is continuous between you your family
11:42 doctor and your um
11:45 and your farmer’s list um a personal
11:48 care plan and that is something that we
11:49 do provide um with the migraine pharmacy
11:52 network i’m gonna talk about the
11:54 migraine pharmacy network but a personal
11:56 care plan is your own manual because you
11:59 are the expert on you and you are the
12:01 one who really knows what works and what
12:04 doesn’t work and who has the ability to
12:07 make lifestyle changes but if we make
12:10 that small manual saying i know that
12:12 this these are my triggers i know that
12:14 this is something i need to work on and
12:17 we sit together and we discuss these and
12:19 find strategies and prioritize you
12:21 cannot change all your life in one day
12:23 but which ones would have the highest
12:25 impact and how um what does the science
12:28 say
12:29 if we’re able to do this that will make
12:31 sure that your
12:34 your commitment to that personal care
12:36 plan becomes a little bit higher and
12:38 you’re more involved in your care plan
12:41 as well whether it’s the the treatment
12:42 plan with your doctor but also your
12:44 lifestyle plan
12:46 of course we do
12:48 expect that if you do see the pharmacist
12:51 you will be able to follow up with them
12:53 assess changes and adjust if needed if
12:55 there was a recommendation that was made
12:58 and you tried it and it didn’t work or
13:00 you had side effects and you needed to
13:02 get
13:03 advice on how to manage your side effect
13:05 then the best person to sit with and go
13:08 over this again is your pharmacist your
13:10 pharmacist is accessible your pharmacist
13:14 is very easy to talk to you don’t need
13:16 an appointment if you need longer time
13:18 yes you can book an appointment you can
13:20 always call your pharmacist and have
13:22 that have them answer your questions and
13:25 if you need a proper follow-up that
13:27 requires more time you can always ask
13:29 them when is a good time or just drop by
13:31 and say is this a good time um i will
13:34 remind you and this is something that i
13:36 always always want to remind you
13:38 you
13:40 never
13:40 fail
13:42 a medication a medication
13:44 fails you
13:45 if a medication doesn’t work for you
13:47 it’s not because you failed the
13:49 medications because the medication
13:51 failed to deliver what it’s supposed to
13:53 do and this is very important for us to
13:55 continue to remind ourselves and work
13:59 with a pharmacist who will be able to
14:02 um
14:03 continue to encourage you to try
14:05 different things to
14:07 be patient and also know when to quit
14:10 when it’s time to say you know what no
14:12 that’s that’s enough you you cannot
14:14 tolerate the side effects or you’re
14:15 having a side effect
14:17 that cannot be tolerated or also works
14:19 with you on doses are the doses going to
14:21 be higher or lower are we gonna titrate
14:24 up or are we gonna taper down all of
14:27 this it’s a great idea to have a
14:28 pharmacist work with you on
14:31 so i started telling you about the
14:33 migraine pharmacy network the migraine
14:35 pharmacy network started
14:37 almost a year
14:39 and a half i’m going to say
14:41 and it’s it’s currently available in
14:43 ontario
14:44 um it is free
14:46 um and it is a group of pharmacy um
14:51 it’s a it’s a group of pharmacies and
14:53 specialized pharmacists that provide
14:55 enhanced support we ensure that they’re
14:58 trained on the latest strategies on the
15:00 guidelines that are accepted in canada
15:04 that are
15:04 um and the the actual design of the
15:07 program was done uh with the leading
15:10 canadian headache specialists clinical
15:12 pharmacists and specialized family
15:14 physicians that are experienced in
15:16 migraine and headache management which
15:19 means that we are only giving
15:22 guidelines that are supported by science
15:25 and when something is not well supported
15:27 we’re also able to tell you that yes
15:29 you can do this however the support or
15:31 the evidence is not as good um as i said
15:35 currently it is free of charge in
15:37 in ontario for patients who qualify and
15:41 the reason for the qualification is the
15:43 number of um
15:45 you know the amazing number that we have
15:48 had and the the resources are at this
15:50 point we’re trying to build resources so
15:52 we’re trying to prioritize those who
15:54 need us most so we’re trying to find
15:57 those who have tried more than one
15:59 preventative and they’re really
16:00 suffering they’re not able to um find a
16:04 a solution um
16:07 we are working on other um um on coming
16:11 into other uh provinces um
16:15 be patient uh we’re trying our best and
16:17 we’re trying to get this to as many uh
16:20 people who are living with migraine as
16:22 we can
16:24 so how can you
16:26 find a migraine pharmacist um today we
16:29 are
16:30 hosted by migraine canada again thank
16:32 you very much but the other thing that
16:34 they’re providing us with is um
16:38 a place where we can actually um have
16:41 our
16:42 patients uh go to and our
16:45 um
16:46 and find these pharmacists that are have
16:49 enhanced training so you go to migraine
16:51 canada i’ve highlighted where you go you
16:53 go under posts and click on news and
16:56 then
16:57 there is the
16:59 migraine pharmacy network and when you
17:01 click on the highlighted clicking here
17:04 it will give you a list of
17:06 current
17:08 pharmacies that are available and
17:12 find one next to you
17:15 it’s best that you can find one next to
17:17 you because it means that you might also
17:19 want to go see them however um
17:22 the other way to find a migraine
17:25 pharmacist is to go to well.ca and you
17:29 go to well.ca backslash migraine and it
17:33 will take you to the migraine
17:37 page where again this is a virtual
17:39 pharmacist you can book with the
17:41 pharmacist uh we also have a nurse who’s
17:43 also helping so
17:46 you click
17:47 and
17:55 click
17:58 start do most of like 99 percent of our
18:01 patients uh go through um
18:04 uh go through a zoom cool and um we do
18:08 the screening and we do the uh we do the
18:10 pre-screening you do your pre-screening
18:11 and you do your appointment and we come
18:14 up with a
18:15 um
18:16 a custom action all you need to do is
18:18 just click on get started and you should
18:21 get there at no time
18:23 of course i’m i
18:25 if you’re here today
18:27 or tonight you know that migraine is not
18:31 um it’s not something that happens in
18:32 isolation um we would like to look at
18:36 you as a as an overall
18:39 um
18:40 not your migraine we are not managing
18:43 your migraine we are managing you and
18:46 your expectations and how you would like
18:49 to
18:49 um manage um
18:52 what your expectations are what what is
18:55 success for you and what else are you
18:58 suffering from and how can we
19:00 reduce the number of tablets so if we if
19:02 you have another condition and uh you
19:05 also have uh migraine we will try to
19:08 find
19:09 let’s say a preventative that manages
19:11 both so that we reduce the number of
19:12 pills you take
19:14 we’ll also look at side effects if you
19:16 are suffering from a certain condition
19:19 if you
19:19 have constipation and we’re prescribing
19:23 something or we’re recommending
19:24 something that does cause constipation
19:27 then we will need to find something else
19:29 that has less of a risk to do this so
19:32 that it doesn’t compound that uh
19:34 condition um and as you can see um there
19:38 there are
19:39 dozens of of medical conditions that
19:42 migraine is related to or it does
19:45 coexist and is comorbid with and it’s
19:48 very important that you tell your
19:49 pharmacist and you tell your doctor
19:51 every time you see them what else are
19:54 you going through what else are you
19:56 feeling and what other medications
19:58 you’re taking
20:00 so um this was it in terms of what your
20:04 pharmacist can do for you
20:06 we are going to start a small poll so if
20:09 you’ve just
20:11 joined us
20:12 [Music]
20:14 this is when we’re going to just start
20:16 by asking you a quick question
20:20 and
20:21 um
20:22 just bear with me
20:24 the first thing that we’d like to know
20:26 um is
20:28 where are you joining us from today so
20:31 that we can make sure in the future that
20:32 our timing actually suits your um
20:36 you know your your your location and i
20:39 know that i’ve seen some are joining us
20:41 from the states welcome
20:43 i’m sorry we have it
20:45 we haven’t
20:46 uh
20:48 okay didn’t go through
20:51 let me redo this i’m relaunching sorry
20:54 but i’m i’m already i already launched
20:56 that so i’m with you i’m with you
20:59 even though i’m mute
21:01 okay so if you’re joining us from the
21:03 states sorry we haven’t added other but
21:05 just let us know i know some of you have
21:09 started
21:11 writing in the in the chat
21:13 box
21:14 just let us know and we will also ensure
21:17 that in the future our event
21:19 is
21:20 um
21:24 so at a time
21:25 that is suitable for everybody so
21:28 30
21:30 seconds
21:32 we still have some
21:41 okay you want us to
21:43 end the poll
21:45 what do you think
21:47 okay so i can see we have bc
21:51 mostly uh
21:53 we have ontario we have quebec
21:56 and we have bc and alberta and as i said
21:59 i saw that we had some from the states
22:01 so thank you very much um
22:04 then the next part is gonna be
22:08 on
22:10 um
22:12 since we’re going to talk about
22:13 supplements let me just quickly
22:17 i’ll share results if you want to take a
22:19 quick look
22:33 uh can you still see me
22:37 yeah i shared the results and we can we
22:40 can see we can see those everybody saw
22:42 that so we can move on to the next poll
22:44 if you like
22:49 okay so the next poll is going to be
22:52 about
22:53 magnesium
22:54 because we’re going to talk about
22:57 supplements and the first one we’re
22:58 going to talk about is magnesium
23:01 coming up
23:02 there we go so what is the best
23:04 magnesium supplement for migraine
23:10 okay
23:27 wow
23:29 i love the participation
23:36 okay results are shared
23:39 perfect
23:47 okay
23:48 so i’m going to try to go back
23:52 to my
23:53 screen
23:55 so
23:56 magnesium citrate glycinate absolutely
23:59 so that was the majority magnesium oxide
24:02 if you’re if you’re from the states and
24:04 you did answer magnesium oxide yes in
24:07 the states also they use magnesium oxide
24:09 but we’re going to talk about the
24:11 canadian guidelines and the canadian
24:13 guidelines actually
24:15 recommend
24:17 citrate and glistenate or biscuit over
24:19 magnesium oxide or sulfate
24:23 okay let me just get this out of the way
24:26 i’m not sure if you can see
24:29 that it’s blocking my screen
24:32 here we go
24:35 so
24:36 when we talk about
24:38 supplements and migraine many people try
24:40 supplements to help with their symptoms
24:42 there are many different
24:44 supplements that claim to be helpful
24:47 there is limited evidence and obviously
24:50 there’s very limit there are very
24:51 limited proper clinical trials on a lot
24:54 of
24:56 the claimed
24:58 supplements however only very few um
25:01 have evidence and we’re going to talk
25:03 about the top three
25:05 today and these are riboflavin and that
25:08 is b2
25:09 magnesium and co enzyme
25:12 q10 so to start with
25:21 magnesium can be used to prevent
25:23 migraine attacks but we also have seen
25:25 some studies saying that when you’re in
25:27 the middle of a migraine attack if you
25:30 increase your magnesium intake there’s
25:32 also abortive properties to magnesium um
25:35 magnesium cannot be
25:37 measured uh with with a blood test
25:39 obviously um a lot of my
25:44 my patients come and say well i did a i
25:47 did a a panel and and nobody told me i
25:50 have magnesium
25:51 deficiency it’s the intracellular so
25:54 it’s the magnesium inside the cells that
25:57 matters and that does not get tested in
25:59 a lab that usually is only research and
26:01 they found that patients who have uh in
26:04 the middle who are in the middle of a
26:05 migraine attack actually have depleted
26:06 magnesium inside the cells and that’s
26:09 why supplementing as preventative and
26:11 also giving extra around a migraine
26:14 attack is a very very good idea
26:17 it helps with muscle spasms it improves
26:19 the mood it helps with sleep not just
26:21 any sleep
26:22 restorative sleep that’s the sleep when
26:24 you wake up you feel that you had a good
26:27 night’s sleep
26:29 heart health and
26:30 bowel movement certain formulations the
26:33 dosa is recommended is 600 milligram
26:36 daily for prevention
26:41 um vitamin b2 riboflavin or riboflavin
26:45 whatever you want to call it
26:47 i get a lot of
26:49 our
26:50 patients come in and
26:53 say i’m already on b12
26:55 and that is not it or they say i’m
26:57 already on b complex that’s not it
26:59 because in b complex it has all of the b
27:02 group but it doesn’t have the
27:04 recommended
27:05 daily intake that we want you to be
27:07 taking uh clinical trials have showed
27:10 that we need 400 milligram of riboflavin
27:13 a day to cut the number of migraine
27:15 attacks in half so it’s a perfect uh
27:20 preventative
27:21 and it clinical trials although there is
27:24 limited and they’re small but they say
27:25 that we do need
27:29 at least 400.
27:30 most of the
27:32 supplements that have more than one have
27:34 around 50. so you will need a lot of
27:37 tablets or a lot of capsules to reach
27:39 that 400. it’s preferred that you buy it
27:42 separate
27:44 coenzyme q10 is also called coq10 as
27:47 well is an essential player in
27:50 also energy metabolism in the brain so
27:52 it’s very important for brain health it
27:54 has a lot of um
27:57 other um uses we we see it used for
28:00 people who are on
28:03 lipid lowering
28:05 medications or who want heart health
28:07 supplements it’s a very good supplement
28:10 it
28:11 if you take a hundred milligrams three
28:13 times a day
28:15 they found also in
28:18 clinical trials that when they gave
28:20 patients a hundred milligrams three
28:22 times daily versus giving them just a
28:24 sugar pill that they did much much
28:26 better
28:27 um again i’m we’re just going to go for
28:29 the next poll that is on supplements
28:32 um
28:34 would you like to do this
28:36 coming right up
28:44 so just
28:46 to remind you
29:02 all right yeah i’m not sure if single
29:04 choice got some of our viewers a little
29:07 bit confused
29:08 um
29:12 okay i’m ending that
29:15 yeah so
29:16 actually it’s all of the above it helps
29:18 with sleep muscle spasms and migraine
29:20 prevention and i think the the single
29:23 choice
29:24 possibly uh got us a little bit um
29:28 confused so um i always
29:31 get the question so which supplement
29:33 should i buy i always they ask me what
29:36 brand how do i make sure that it’s the
29:38 right one um a lot of people think it’s
29:41 the most expensive one must be the best
29:42 one and i i just want to give you a
29:45 couple of um like
29:48 pointers for when
29:50 for how you can choose the best
29:52 supplement for you
29:55 if you look
29:58 here you will see that a lot of
30:01 a lot of magnesium
30:03 is recommended the top two are the
30:05 citrate glycinate in canada these are
30:07 the only two but also we have other like
30:09 three on eight that is is the only one
30:12 that claims to to to cross the
30:14 blood-brain barrier very expensive um i
30:18 haven’t seen any proper trials in
30:20 migraine but in principle it it it
30:24 crosses the blood-brain barrier so
30:26 there’s a a feeling that it should work
30:29 better but it’s much much more expensive
30:31 than the magnesium citrate and the
30:33 glycemic that are already studied so
30:35 to start with always read the
30:37 ingredients find out what is um what is
30:40 it that’s inside not just magnesium
30:43 because sometimes it does say magnesium
30:45 but it does have other stuff it has
30:49 uh calcium and vitamin d and and
30:54 then it means that when you look at the
30:56 magnesium itself you will find that it’s
30:58 a combination of sulfate with oxide with
31:01 citrate so we wouldn’t know exactly how
31:03 much are you getting of the citrate read
31:05 the ingredients make sure that they’re
31:07 lactose free and and gluten-free free if
31:10 you can
31:11 most of um of again people suffering
31:14 with migraine or living with migraine
31:17 actually have other conditions with
31:19 their stomach so make sure that you
31:20 eliminate it to start with if you can
31:23 and if you find one that is reasonably
31:25 priced non-gmo source obviously because
31:28 again we don’t know we still don’t know
31:31 if there’s any effect but if you can
31:33 that is something that you can do
31:35 um
31:37 find a supplement that has one of the
31:38 studied or proven to help formulas as i
31:41 said magnesium citrate or glycinate and
31:44 less of one that has three or four
31:46 different um
31:48 formulations in one um provide the
31:51 maximum amount of elemental magnesium
31:53 for instance uh with the least number of
31:55 tablets so uh if it’s 50 and the dose is
31:58 supposed to be 600 then it means you
32:01 have to take 12 of those
32:03 that’s not a good idea we would need you
32:05 to get less number of tablets or
32:08 capsules um throughout the day for you
32:11 to get the best out of it and of course
32:13 consider the cost it’s you’re not
32:15 supposed to
32:16 just get the most expensive and not be
32:19 able to afford it because you need to
32:20 take your supplements for three months
32:22 in a row
32:23 before you can tell if they’re working
32:25 for you or not working for you so that’s
32:27 it in in in a nutshell if you have more
32:30 questions about how to choose
32:31 supplements please send me some in the
32:33 question answer we’ll try to answer them
32:38 um
32:40 lifestyle and migraine
32:43 we’re going to talk about lifestyle
32:45 changes and that’s uh i think i’ve i’ve
32:47 taken a lot of time so i’ll try to make
32:49 it very fast we know that lifestyle does
32:53 affect migraine and does affect the
32:55 threshold of migraine and how
32:58 severe the migraine
33:00 attack can
33:02 can can can be and by us trying to
33:05 reduce the triggers that are related to
33:07 sleep exercise it sees is we we use the
33:11 acronym
33:12 seeds it’s
33:15 sleep
33:17 exercise
33:19 uh eat diary and stress so if we’re able
33:22 to reduce and to manage these then we
33:25 will be
33:26 able to
33:28 best manage our migraine
33:31 that’s it i’m ready to take your
33:33 questions thank you very much
33:35 um if also you have any questions
33:39 you can send to migraine canada migraine
33:41 pharmacy network or well.ca pharmacy and
33:44 we will be happy to answer them