Background <p>Migraine is a prevalent neurological disorder and a leading cause of disability worldwide. Despite effective medications, many patients experience underdiagnosis, suboptimal medication use, and poor adherence. Pharmacists are well-positioned to provide medication counselling, yet their role in structured migraine counselling services within community pharmacy practice remains underexplored.</p> Objective <p>This pilot study explored pharmacists’ experiences and patient-reported consultation outcomes associated with a pharmacist-led migraine consultation service in community pharmacies, with the aim of generating exploratory evidence to inform future implementation.</p> Methods <p>A mixed-methods prospective pilot service evaluation was conducted, and findings were interpreted using an implementation science perspective. Pharmacists from 19 Norwegian community pharmacies received targeted training and conducted structured migraine consultations between May 2023 and January 2024. Each patient was offered two consultations. In total, 198 first consultations and 44 follow-up consultations were completed. Semi-structured pharmacist interviews were analysed qualitatively, and patient-reported motivation for and experiences with the consultations, use of recommendations, and changes in frequency and/or severity of migraine attacks were assessed using self-reported and pharmacist-reported questionnaires. Chi-square tests and Wilcoxon signed-rank tests were used to explore differences between observations.</p> Results <p>Pharmacists reported that migraine consultations were perceived by pharmacists as implementable within pharmacy practice, professionally valuable, and strengthened their role in primary healthcare. Time constraints and funding were noted as barriers. Overall patients reported positive consultation experiences (adjusted <i>p</i> &lt; 0.011). Among patients returning for follow-up consultations, 69% reported having implemented at least one recommendation from the pharmacist at the first consultation, and 38% reported perceived improvement in migraine status. Participants who reported implementing recommendations tended to report fewer and/or less severe migraine attacks; however, this difference did not reach statistical significance (<i>p</i> = 0.085). Motivation for medication use was high both before and after the consultations.</p> Conclusion <p>This pilot service evaluation suggests that pharmacist-led migraine counselling may represent a clinically relevant and potentially useful addition to community pharmacy practice. Responding patients reported positive consultation experiences and reported to be highly motivated to take their medication. The majority implemented at least one recommendation, and many reported perceived improvements in migraine status. However, limited follow-up data indicates that findings should be interpreted cautiously. Larger-scale studies with validated instruments are needed to assess long-term effects and implementation models.</p>