Chapter 52: Drug Therapy for Migraine and Other Headaches
A woman who has just found out she is pregnant states she has "always taken sumatriptan for her migraines." What is the best advice for the nurse to give this patient? "You can continue to take your medication as prescribed." "Take half the dose that you previously took before becoming pregnant." "Try to control your migraines with behavior modification." "Ask your healthcare provider what other medications you can take."
"Ask your healthcare provider what other medications you can take." The medication should only be taken if the benefit outweighs the risk. If another medication can control the migraine, then the patient should avoid sumatriptan while pregnant because of risk to the fetus.
The patient asks how caffeine will help a migraine headache. How should the nurse respond? "Caffeine increases neurological function." "Caffeine causes constriction of blood vessels." "Caffeine helps you cope with the pain." "Caffeine helps block prostaglandin."
"Caffeine causes constriction of blood vessels." Caffeine constricts blood vessels. Migraines are caused by the dilation of blood vessels. Enhancing neurologic function does not help to decrease headaches. Caffeine does not block prostaglandins, nor does it help the patient cope with the pain
A client uses sumatriptan for treating her migraine headaches. Which statement by the client indicates to the nurse that she understands how to take this drug? "I can repeat a dose in 15 minutes for a total of four doses." "I should repeat the dose in 30 minutes for a total of three doses." "I can take another dose 2 hours after the first one." "I can take another dose in about 4 hours, if needed."
"I can take another dose 2 hours after the first one." With sumatriptan, the client should take the first dose at the first sign of a headache and then repeat the dose, if needed, in approximately 2 hours.
What statement indicates the patient needs more teaching about administering sumatriptan subcutaneously? "I will not drive after I take the medication." "I will not take more than two injections in 24 hours." "I can give the medication in my arm or leg." "I can take this medication safely when pregnant."
"I can take this medication safely when pregnant." The medication should not be taken if pregnant. All other statements are correct.
Which statement indicates that more teaching is necessary for the patient taking ergotamine? "I will rest in a dark room after taking the medication." "I will hold off taking the medication until the pain is unbearable." "I will not crush the tablet before taking." "I will not chew the tablet."
"I will hold off taking the medication until the pain is unbearable." The patient should take the medication at the onset of the headache and not wait until it gets worse. The other answers are correct.
What statement indicates the patient understands teaching about naproxen sodium? "I will take the medication at least 2 hours before I eat." "I will crush the pill and put it in applesauce if I have difficulty swallowing." "I will not drive until I see how the medication affects me." "I will take the medication with antacids if my stomach is upset."
"I will not drive until I see how the medication affects me." The medication can cause drowsiness and dizziness, and the patient should determine its effects before driving. The medication should not be crushed. If the medication causes stomach upset, the patient should take it with meals, not with antacids.
A female client calls the clinic and states she has been taking propranolol for the last week to help decrease the incidence of migraine headaches. The client states that there has been no decrease in the number of headaches yet. What is the nurse's best response? "I'm sorry the medication hasn't worked for you. The physician will try a new medication." "It may take up to 3 months to know whether this medication will be effective in preventing your migraine headaches." "The medication will be more effective if you try to relax a little bit more." "Try to drink more decaffeinated beverages and see if that helps decrease the number of headaches you are having."
"It may take up to 3 months to know whether this medication will be effective in preventing your migraine headaches." Propranolol is a beta-blocker and it may take up to 3 months to be effective as a migraine preventative.
A patient with a cluster headache reports that the health care provider did not prescribe anything but "air." What is the nurse's best response to this statement? "Oxygen is a drug." "Oxygen therapy requires a prescription." "Oxygen therapy has been shown to help relieve cluster headaches." "Drugs are not the answer for all headaches or pain."
"Oxygen therapy has been shown to help relieve cluster headaches." The nurse should explain the rationale for the treatment, not address the patient's statement about being prescribed "air."
A patient with a migraine took a dose of a prescribed triptan and 1 hour later the headache is still intense. The patient's husband calls the clinic and asks the nurse what they should do. Which of the following is an appropriate response by the nurse? "Tell her to lie down in a quiet cool room and just wait it out. It will subside." "She can take another dose of the drug." "Give her a dose of an ergot drug if you have it. It will decrease the intensity of the pain." "Ibuprofen may increase the action of the triptan."
"She can take another dose of the drug." A patient taking a triptan to relieve a migraine can take another dose within 1 to 2 hours if the headache is not relieved. The combination of ergot drugs with triptans is not indicated because of the vasoconstriction caused by both. The patient will not get relief by "waiting it out" and ibuprofen is an anti-inflammatory that does not affect the mechanism associated with migraines.
A 50-year-old woman has been prescribed sumatriptan for the treatment of migraines. What instructions should then the nurse provide to the patient about the safe and effective use of this drug? "Take a dose of sumatriptan each morning when you suspect there's a chance of having a migraine." "Take this drug as soon as you feel the first signs of a migraine." "Lie down when you feel a migraine coming on and take some sumatriptan around 30 minutes later." "Take a dose of sumatriptan after you feel that you're unable to endure the pain of your migraine."
"Take this drug as soon as you feel the first signs of a migraine." Administer sumatriptan as soon as the headache begins. Sumatriptan is more efficacious when given before the headache escalates. However, it is not normally taken on a prophylactic basis.
A patient states, "I am not going to take this propranolol (Inderal) any more for my migraines. I have taken it for 3 days and it just does not work!" What should the nurse say to the patient? "I can call your healthcare provider to have another medication ordered." "The dosage can be increased." "The medication takes several weeks to be effective." "The medication is experimental."
"The medication takes several weeks to be effective." Propranolol is used for the prevention of migraines. As such, the primary goals are not reduced duration or intensity of migraines. Beta blockers take several weeks to prevent migraines. The patient should be encouraged to keep taking the drug. The dosage should not be increased until the medication has had enough time to be effective. It is not an experimental treatment. It is commonly prescribed as a medication to prophylactically treat migraines.
A patient has taken sumatriptan (Imitrex) and does not feel it is working. The patient wants to know when she can take more of the medication. What should the nurse tell the patient? "You can double the dose within a few minutes of administration." "You can only take one dose safely." "If it does not work with the first dose, we will add a different medication." "You can take a second dose 2 hours after the first."
"You can take a second dose 2 hours after the first." The dose should not exceed 200 mg/day. The second dose can be taken no more than 2 hours after the first.
For the sumatriptan/naproxen sodium combination (Treximet), the FDA has issued two BLACK BOX WARNINGS ♦ :
(1) Sumatriptan: increased risk of CV thrombotic events (2) Naproxen sodium: GI effects - ulceration, bleeding, perforation
Which medication will the nurse administer to the patient who reports nausea and vomiting related to a migraine headache? Sumatriptan (Imitrex) Metoclopramide (Reglan) Naproxen sodium (Naprosyn) Ergotamine
Metoclopramide (Reglan) Metoclopramide is a medication to decrease nausea and vomiting. The other medications will decrease pain with migraine headaches.
A middle-aged patient describes her headaches as "utterly debilitating" and tells the nurse, "It's hard to explain, but I just know when one is coming, and I'm never wrong." This patient's statement suggests that she has what diagnosis? A) Migraines B) Cluster headaches C) Tension headaches D) Ischemic headaches
A) Migraines Feedback: The severity of her headaches coupled with the fact that she experiences a prodrome suggests that she experiences migraines. This clinical presentation is not typical of cluster headaches or tension headaches. Ischemic headache is not a recognized subtype.
The nurse at a long-term care facility is assessing a new resident's current medication regimen, and the resident states that she often takes an OTC remedy when she experiences a migraine. She has brought the bottle with her, and the nurse notes it to be Anacin Advanced Headache Formula. The nurse should document that the patient takes which drugs? Select all that apply. A) Codeine B) Acetaminophen C) Aspirin D) Caffeine E) Naproxen
B) Acetaminophen C) Aspirin D) Caffeine Feedback: Anacin Advanced Headache Formula and other similar OTC formulations includeacetaminophen, aspirin, and caffeine.
4 phases of migraine headaches w/ aura
1. Prodomal 2. Aura 3. Headache 4. Recovery
NSAIDS:Older people should not take more than ______of naproxen sodium every 12 hours.
200 mg
Which medication therapy is correctly prescribed for the patient's condition? A patient with tension headaches receiving opioid therapy A patient with cluster headaches receiving oxygen therapy A patient with migraine headaches receiving oxygen therapy A patient with tension headaches taking caffeine
A patient with cluster headaches receiving oxygen therapy The patient with a cluster headache can be treated with oxygen therapy. Opioid therapy is not typically given for tension headaches. A patient with a tension headache does not generally take caffeine. A patient with migraine headaches is not treated with oxygen therapy, but with drugs or therapies that cause vasoconstriction.
A nurse should recognize clients with contraindications to the use of selective serotonin agonists. Which of the following clients have a contraindication to the use of selective serotonin agonists? Select all that apply: A client with diabetes A client with uncontrolled hypertension A client with angina A client with hyperlipidemia A client with transient ischemic attacks
A client with uncontrolled hypertension A client with angina A client with transient ischemic attacks The use of selective serotonin agonists is contraindicated in clients with ischemic heart disease, transient ischemic attacks, uncontrolled hypertension, or those taking MAO inhibitor antidepressants.
A patient has been diagnosed with migraines after experiencing headaches of increasing severity. When providing health education to this patient about her new diagnosis, what should the nurse convey? A) The etiology of migraines is thought to have a genetic component. B) Migraines are typically the result of prolonged psychosocial stress. C) Migraines can be a precursor to transient ischemic attacks (TIAs) or stroke. D) The pathophysiology of migraine headaches involves a disruption in the limbic system.
A) The etiology of migraines is thought to have a genetic component. Feedback:Migraines demonstrate a familial pattern, and authorities believe that they are inheritedas autosomal dominant traits with incomplete penetrance. Stress may precipitate amigraine, but this is not an aspect of the etiology. They are not a precursor to TIAs or stroke, and they do not involve disruption of the limbic system.
A patient experiences debilitating migraines on a frequent basis and has had oral prochlorperazine (Compazine) added as an adjuvant medication to abortive therapy. When teaching the patient to take this drug safely in the home setting, the nurse should emphasize what teaching point? A) The importance of taking the pill whole and not crushing or splitting it B) The importance of having a bimonthly complete blood count (CBC) drawn C) The need to avoid taking the drug after eating fatty food D) The need to be aware of the potential for hypotension
A) The importance of taking the pill whole and not crushing or splitting it Feedback: When taking prochlorperazine orally, it is important to swallow it whole and not chewor crush the tablets. Blood work is not warranted, and there is no need to avoid fattyfood prior to taking the drug. Compazine is not noted to cause hypotension.
A 16-year-old girl develops migraine headaches. Which of the following medications is safe and effective for the treatment of migraine headaches? A) antiepileptic agents B) triptans C) ergot alkaloids D) opioids
A) antiepileptic agents Antiepileptic agents such as valproic acid are the safest medications to administer to a 16-year-old child. However, the safety and efficacy of these agents have not been established in clients younger than 18 years of age.
Which of the following medications are administered for preventive therapy in the treatment of migraine? A) beta-adrenergic blockers B) nonsteroidal anti-inflammatory agents C) ergot alkaloids D) analgesics
A) beta-adrenergic blockers
A patient is taking naproxen sodium for headache and lithium for manic depression. Which of the following effects occurs when the naproxen is administered in combination with lithium? A) increased risk of lithium toxicity B) increase in creatinine clearance C) hepatotoxicity D) potential gastrointestinal effects A) increased risk of lithium toxicity
A) increased risk of lithium toxicity
Abortive therapy vs Preventive therapy
Abortive therapy : medications administered in the treatment of symptoms of migraine headache Preventive therapy: administration of medications to prevent the onset of migraine headaches
The nurse is planning care for the client who has been admitted to the emergency department with an acute migraine headache. What is the most appropriate nursing diagnosis for this client? Fluid volume excess Acute pain Activity intolerance related to muscle pain Fear related to migraine headache
Acute pain The most appropriate nursing diagnosis for this client is acute pain. There is no indication that the client has fluid volume excess or activity intolerance related to muscle pain or that the client is full of fear.
A patient with migraine headaches has changed his diet and stopped drinking soda and coffee. The patient is seen in the emergency department with increased headaches. What is the nurse's best action? Administer medication to help abort the migraine. Have the patient drink coffee. Keep the patient in a dark room. Administer caffeine in pill form.
Administer medication to help abort the migraine. The patient may be having increased headaches from decreasing intake of caffeine. The patient should be given some other type of medication to help to abort the headache. The nurse should not give the patient more caffeine.
The nurse observes that a new client's medication regimen includes sumatriptan. What assessment should the nurse prioritize? Assessing the client for migraine pain Assessing the client for narcotic withdrawal syndrome Assessing the client for respiratory depression Assessing the client's lying, sitting and standing blood pressure
Assessing the client for migraine pain Sumatriptan is indicated for the treatment of acute migraine and cluster headaches. As such, the nurse should assess the client for indications of this health problem, more so than respiratory status or blood pressure. Narcotic withdrawal syndrome is unrelated.
The nurse is giving instructions to a client who has just been prescribed sumatriptan for the treatment of migraine headaches. The client will be instructed to take this medication at what time? Every day at the same time At the onset of migraine symptoms Every 5 minutes until the pain goes away After other migraine medications have been ineffective
At the onset of migraine symptoms Sumatriptan should be taken at the onset of migraine symptoms
Mrs. Gonzaga is a 60-year-old woman who first began having headaches during the onset of menopause and who has subsequently been diagnosed with migraines. She tearfully explains to the nurse how her husband downplays her health condition and tells her that she needs to "just push through a headache." She describes how her migraines have limited her ability to provide childcare for her young grandchildren and explains that she is unable to keep up her garden. The nurse should identify what nursing diagnosis when planning Mrs. Gonzaga's care? A) Ineffective health maintenance related to migraine headaches B) Ineffective role performance related to migraine headaches C) Situational low self-esteem related to migraine headaches D) Spiritual distress related to migraine headaches
B) Ineffective role performance related to migraine headaches Feedback: Many nursing diagnoses likely apply to this patient's situation, but there is evidence thatshe grieves her inability to perform a caregiving role for her grandchildren. There is noevidence that the patient's health maintenance is inadequate or that she has low selfesteem. Spiritual distress is also not in evidence.
A nurse in surgical daycare is completing a preoperative assessment of a woman who will undergo hip arthroplasty. The nurse has questioned the woman about her daily use of gabapentin (Neurontin), and the woman has stated that she takes this drug to treat her migraines. What role does this drug play in migraine treatment? A) It reduces the intensity of menstrual migraines. B) It prevents migraines from occurring. C) It relieves acute migraine pain. D) It lengthens the aura that precedes a migraine.
B) It prevents migraines from occurring. Feedback: Studies have shown that gabapentin is effective in reducing the frequency of migraines.Gabapentin is not an abortive treatment.
A nurse has administered a scheduled dose of naproxen to a hospital patient who has been taking the drug for several weeks. What assessment finding should cause the nurse to suspect that the patient is experiencing adverse effects of this drug treatment? A) There is an increase in the patient's neutrophils but no increase in temperature. B) The patient's stool tests positive for occult blood. C) The patient complains of itchy, dry skin. D) The patient has peripheral edema and there is a steady increase in the patient's weight.
B) The patient's stool tests positive for occult blood. Feedback: GI bleeding is a significant adverse effect of naproxen. This drug does not typicallycause leukocytosis, dry skin, or fluid imbalances
A teenage girl is suffering from migraine headaches. Her health care provider orders a combination of acetaminophen, aspirin, and caffeine. Prior to the administration of the medication, it is necessary to assess for which of the following? A) anxiety and depression B) history of smoking C) family history of migraines D) antacid use
B) history of smoking The administration of aspirin, acetaminophen, and caffeine in a client who smokes decreases the effects of caffeine to treat the migraine pain.
A patient is admitted to the emergency department with a severe headache with nausea and vomiting. She receives a diagnosis of an acute migraine headache. Which of the following medications assists in decreasing the nausea and vomiting related to the acute migraine episode? A) intravenous ketorolac B) subcutaneous sumatriptan C) inhaled albuterol D) oral diclofenac
B) subcutaneous sumatriptan The patient can receive a subcutaneous medication to treat the migraine. This is the best intervention. You would not want to give an antacid with the medication, because absorption could be altered. Making certain the patient retains the medication or giving dry crackers prior to the medication does not guarantee the patient will not vomit the medication or a portion of it. It is best to prevent the patient from vomiting the remedy by administering medication by an alternate route.
A woman in her 40s has been living with migraines for many years, and these have only just been identified as being linked to her menstrual cycles. Estradiol has been prescribed, which the nurse will administer A) intravenously. B) transcutaneously. C) intramuscularly. D) sublingually.
B) transcutaneously Feedback: Estradiol for the treatment of migraines is administered by the transcutaneous route.
A nurse is providing teaching to a client who is experiencing migraine headaches. Which of the following instructions should the nurse provide? (Select all that apply) A: Take ergotamine as a prophylaxis to prevent a migraine headache B: Identify and Avoid trigger foods C: Lie down in a dark quiet room at the onset of a migraine D: avoid foods that contain tyramine E: Avoid exercise that can increase the HR
B: Identify and Avoid trigger foods C: Lie down in a dark quiet room at the onset of a migraine D: avoid foods that contain tyramine Also: Ergotamine should be taken at onset of a migraine and exercise between migraines is encouraged
Prophylactic treatment include which for the treatment of migraine headaches? Select all that apply. Beta blockers Calcium channel blockers Antidepressants Anticonvulsants Selective serotonin agonists
Beta blockers Calcium channel blockers Antidepressants Anticonvulsants Beta blockers, calcium channel blockers, antidepressants, and anticonvulsants are used prophylactically to prevent spasms that cause migraine headaches. Selective serotonin agonists are used to treat the acute pain of a migraine headache.
A patient has been treated for migraines on an ongoing basis and the care provider has just prescribed sumatriptan. Which of the following is the priority intervention for patient education? A) "You might get dizzy and lightheaded after you take sumatriptan, but this is normal." B) "It's important that you never take Tylenol within 12 hours of sumatriptan." C) "Make sure that you stop taking ergotamine before you get this prescription filled." D) "You will likely experience a brief worsening of your migraine before this drug relieves the pain."
C) "Make sure that you stop taking ergotamine before you get this prescription filled." Feedback: It is important to ask the patient about recent administration ergot alkaloids. The ergot alkaloids should not be given within 24 hours of the administration of triptans. Signs of low blood pressure should be reported promptly, and there is no particular reason to avoid acetaminophen. Triptans do not make symptoms worse before they provide relief.
A 50-year-old woman has a subarachnoid bleed. She has received treatment for migraine headaches in the past. Which of the following patient teaching guidelines is a priority on her discharge from the rehabilitation facility? A) Take estrogen to prevent a menstrual migraine. B) Take gabapentin for neuropathic pain. C) Do not take sumatriptan for migraine headache. D) Take zolmitriptan because it has a more rapid onset of action.
C) Do not take sumatriptan for migraine headache. Due to the risk of vasospasm and thromboembolism, the triptans should not be administered following a subarachnoid bleed.
A patient who lives with migraines has been prescribed naproxen. The nurse should recognize that this drug achieves a therapeutic effect through which of the following means? A) Demyelinizing pain fibers in the CNS B) Selectively antagonizing opioid receptors in the CNS C) Inhibiting the synthesis of COX-1 and COX-2 D) Slowing the reuptake of serotonin and acetylcholine in brain synapses
C) Inhibiting the synthesis of COX-1 and COX-2 Feedback: Naproxen is a nonselective inhibitor of cyclooxygenase resulting in the inhibition of prostaglandin synthesis of COX-1 and COX-2. It does not involve serotonin, acetylcholine, or opioid receptors.
A patient with migraine headaches receives a prescription for an ergot alkaloid as abortive therapy. Which of the following is a priority intervention for patient education? A) Notify the prescriber if an aura precedes the migraine headache. B) Administer the medication with food. C) Seek emergency help if cardiac changes occur. D) Administer the medication with caffeinated beverages.
C) Seek emergency help if cardiac changes occur. The administration of ergotamine or ergot alkaloids can cause life-threatening cardiac changes. It is essential to instruct the client to notify the prescriber if changes
A patient who is well-known to the clinic asked if it would safe for him to take Excedrin Extra Strength for the treatment of a severe headache. The nurse is well aware of this patient's medical history and should advise against using this medication based on what aspect of his current health status? A) The patient has not adhered to previous treatment regimens. B) The patient has a chronic venous ulcer on his lower leg. C) The patient has a diagnosis of liver cirrhosis. D) The patient is a smoker.
C) The patient has a diagnosis of liver cirrhosis. Feedback: People with hepatic impairment should not receive this combination agent on an ongoing basis. They may not metabolize acetaminophen in this combined medication effectively, leading to hepatotoxicity. Lack of previous adherence, cigarette smoking, and the presence of skin ulcers do not necessarily contraindicate the use of this drug.
A nurse is teaching a patient how to take Imitrex in the home setting in order to maximize therapeutic benefit while reducing the risk of adverse effects. The nurse should teach the patient to take Imitrex A) before breakfast each day. B) on days when migraines may be anticipated. C) as soon as the earliest symptoms of migraine are sensed. D) when the pain of a migraine becomes too much to bear.
C) as soon as the earliest symptoms of migraine are sensed Feedback: It is important to administer sumatriptan at the onset of migraine symptoms. The drug is not taken on a daily, scheduled basis and is not used as a preventative treatment.
A 14-year-old girl is diagnosed with menstrual migraines. Which of the following factors prevents the use of estradiol for the treatment of menstrual migraines? A) breakthrough bleeding B) leg pain C) incomplete long bone growth D) anxiety
C) incomplete long bone growth A 14-year-old girl has not fnished growing. Incomplete growth of the long bone contraindicates the administration of estradiol.
A young man has been diagnosed with migraines, and the nurse is teaching him about abortive therapy. The primary goal of this form of therapy will be to A) permanently correct the patient's brain physiology. B) ensure that the patient experiences fewer migraine headaches. C) relieve the symptoms of the patient's migraines. D) foster coping skills that will allow the patient to live with his migraines.
C) relieve the symptoms of the patient's migraines. Feedback: Abortive therapy is the administration of medications to treat the symptoms of migraine headache. These medications do not provide a permanent correction of pathophysiological neurological function, and they are not preventative. Coping skills are not provided through medications.
A nurse is providing teaching to a client who has migraine headaches and a new prescription for ergotamine. For which of the following adverse effects should the nurse instruct the client to stop taking the medication and notify the provider. Select all that apply. A: Nausea B: Visual Disturbances C: Positive pregnancy test D: Numbness and tingling in fingers E: Muscle pain
C: Positive pregnancy test D: Numbness and tingling in fingers E: Muscle pain Numbness and tingling in fingers as well as muscle pain is a sign of an OD. Nausea and visual disturbances are common migraine symptoms
The nurse assesses the client who has frequent migraine headaches. The client reports that headaches seem to occur more frequently when he eats which foods? (Select all that apply.) Fried chicken Chinese food Diet beverages American cheese Chocolate cake
Chinese food Diet beverages Chocolate cake Specific foods that may trigger a migraine headache are aged cheese, monosodium glutamate (found in Chinese foods), chocolate, aspartame (found in diet beverages), and fermented foods.
A client has had symptoms of a migraine headache approximately 2 to 3 days per week for the last 3 months. The nurse is aware that this client has developed what condition? Cluster headache Chronic migraine headache Tension headache Brain tumor
Chronic migraine headache Clients are diagnosed with chronic migraine headaches when they have symptoms of migraine headache at least eight times per month for at least 3 months.
A middle-aged patient has not achieved adequate symptom relief of migraines with first-line therapies, and the clinician is considering the use of frovatriptan (Frova). The patient's concurrent use of what medication would contraindicate the safe use of frovatriptan? A) Albuterol (Ventolin) B) Metformin C) Atorvastatin (Lipitor) D) Fluoxetine (Prozac)
D) Fluoxetine (Prozac) Feedback: Frovatriptan (Frova) interacts unfavorably with selective serotonin reuptake inhibitors and may lead to serotonin syndrome. Ventolin, metformin, and Lipitor do not present a risk for interactions.
A young woman who is 14 weeks pregnant has sought care because she has been experiencing migraine headaches with increasing severity and frequency in recent months. She states, "My headaches used to be something I could live with, but now they're affecting every other part of my life." The patient has conducted online research and requested a prescription for ergotamine. How will this patient's current health status affect the clinician's response to this request? A) The patient can safely use ergotamine but must be monitored for blood dyscrasias. B) The patient must use a reduced dose of ergotamine until she has given birth. C) The patient must wait until she has given birth before taking ergotamine. D) The patient cannot safely take ergotamine until she has weaned her infant.
D) The patient cannot safely take ergotamine until she has weaned her infant. Feedback: Pregnancy and lactation are contraindications to the use of ergotamine.
A patient has taken sumatriptan-naproxen sodium for an acute migraine. She has also taken over-the-counter ibuprofen for menstrual cramps. Which of the following adverse effects is she at risk for developing? A) bronchospasm B) urinary retention C) edema D) gastrointestinal bleeding
D) gastrointestinal bleeding A client who takes sumatriptan/naproxen along with ibuprofen is at risk for developing a gastrointestinal bleed. It is important to instruct the client not to take any non- steroidal anti-infammatory drug with sumatriptan and naproxen.
A 32-year-old woman has been taking ergotamine tartrate as abortive therapy for migraine headache for many years. For which of the following adverse effects does the nurse assess? A) hypotension B) muscle weakness C) hypoventilation D) valvular fibrosis
D) valvular fibrosis
The nurse is caring for a client who has symptoms of menstrual migraine headaches. The nurse is aware that estradiol is contraindicated if this client has a history of what disorder? Allergy to penicillin Deep vein thrombosis Menstrual irregularity Cluster headaches
Deep vein thrombosis Estradiol is contraindicated in clients who have had a history of deep vein thrombosis because estradiol is a form of estrogen
The nurse is preparing to medicate a client for migraines. The teaches the client that migraine headaches frequently occur for what reason? Due to vasoconstriction Due to vasodilation Due to photophobia Due to ischemia
Due to vasodilation Migraine symptoms are caused by vasodilation, not vasoconstriction, and stimulation of the trigeminal nerves. Ischemia is due to decreased oxygenation and photophobia can worsen the migraine.
Which of the following should a nurse tell a client are the most common adverse reactions associated with sumatriptan (Imitrex)? Select all that apply: Flushing Bradycardia Dry mouth Impaired vision Fatigue
Flushing Dry mouth Fatigue The most common adverse reactions associated with the selective serotonin agonists like sumatriptan (Imitrex) include: dizziness, nausea, fatigue, pain, dry mouth, and flushing.
The client is taking sumatriptan (Imitrex) for migraine headaches. For which client is this medication contraindicated? For clients with a history of allergies to NSAIDs or history of hypertension For clients with a history of hyperglycemia, acute renal failure, or cerebral vascular compromise For clients with a history of angina pectoris, myocardial infarction, or uncontrolled hypertension For clients with a history of a connective tissue disorder or kidney failure
For clients with a history of angina pectoris, myocardial infarction, or uncontrolled hypertension Because of their vasoconstrictive properties, triptans are contraindicated in clients with a history of angina pectoris, myocardial infarction, or uncontrolled hypertension. Use caution with the concurrent use of antidepressants (e.g., SSRIs, SNRIs, and MAOIs), meperidine, and dextromethorphan with triptans because all of these medications have the potential to increase serotonin levels in the brain.
Ergotamine tartrate is a drug used in the treatment of migraines. Cafergot is a mix of ergotamine tartrate and caffeine. What effect of caffeine aids in the treatment of migraines? It decreases blood pressure. It promotes relaxation. It increases urinary output. It increases vasoconstriction
It increases vasoconstriction. By itself, ergotamine may be poorly absorbed. Caffeine reportedly aids in the treatment of migraines by increasing the absorption and vasoconstrictive effects of ergotamine. Since caffeine is a stimulant, it does not promote relaxation or decrease blood pressure. Caffeine may increase urinary output in some people.
Migraine headache 2 key features Associating S/S Trigger foods: (4)
Key features: unilateral pain, sometimes an aura Associating S/S: n/v, vertigo, photophobia Trigger foods: cheese, fermented foods, MSG, chocolate
Prodrome Phase Length S/S
Length: hours/days before migraine S/S: depression, irritability, feeling cold, cravings, loss of appetite, polyuria, diarrhea, constipation
The nurse is caring for a client who has received a prescription for naproxen sodium for the treatment of migraine headaches. This client also takes lithium carbonate for bipolar disorder. The nurse is aware that this client will be monitored for what condition? Decreased lithium levels Decreased naproxen effectiveness Lithium toxicity Increased chance of anaphylaxis
Lithium toxicity When naproxen sodium and lithium carbonate are given together, there is an increased risk for lithium toxicity.
A patient who is the administrator of a large healthcare agency reports constant stress on the job, causing "tension headaches." What therapy will the nurse teach the patient to use? IV medication Running hands under cold water Nonsteroidal anti-inflammatory agents Oxygen therapy
Nonsteroidal anti-inflammatory agents The patient with tension headaches is treated with NSAIDs, rest, relaxation, and stress reduction techniques. IV medication is not used. Running hands under cold water is used for migraine headaches. Oxygen therapy is used for cluster headaches.
A client is prescribed zolmitriptan for migraine headaches. The nurse should instruct the client to administer this drug by which route? Oral Subcutaneous Intranasal Sublingual
Oral Zolmitriptan is administered orally only.
Headache phase Pathology (2) Pain quality (3) Length S/S (3)
Patho: Cerebral vasodilation and low serotonin Pain: throbbing, intense, incapacitating Length: several hours S/S: photophobia, n/v
Cluster headache Describe qualities (3) Related to a ____ reaction Can occur up to ___ times daily Tx (5 options)
Qualities: recurrent, severe, unilateral orbitotemporal headache Related to a histamine reaction Can occur up to 8 times daily Lidocaine Octreotide Oxygen Subcutaneous sumatriptan Ergot derivatives
Both categories of migraine abortive drugs (ergot alkaloids and serotonin agonists) exert powerful vasoconstrictive effects and also have what potential? Lower blood pressure Manage hypertension Raise blood pressure Manage hypotension
Raise blood pressure Both categories of migraine abortive drugs (e.g., ergot alkaloids and serotonin agonists) exert powerful vasoconstrictive effects and have the potential to raise blood pressure.
The nurse is caring for patients admitted with headaches. What statement is true concerning this type of pain? All headaches can be treated with the same medication. All headaches have the same characteristics. The majority of chronic headaches are curable. Some headaches are manageable with opioids.
Some headaches are manageable with opioids. There are multiple types of headaches, requiring many different medication therapies. Some headaches are intractable to all but the strongest medications, such as opioid narcotics. Other headaches are treatable with NSAIDS and even adjuvant medications.
A female client's physician orders an ergot preparation for her migraine headaches. The nurse is responsible for the education plan. What would be the nurse's teaching regarding how the client is to take her medication? Take it at the onset of a headache, and lie down in a quiet, darkened room. Take it when the pain becomes unbearable, so the medication will be more effective. Take it when sleep alone does not relieve the pain. Take it whenever you experience a headache.
Take it at the onset of a headache, and lie down in a quiet, darkened room. If an ergot preparation is used, it should be given at the onset of headache, and the client should lie down in a quiet, darkened room.
A patient is started on topiramate (Topamax). What does the nurse teach the patient about administration? Take the medication in the morning with breakfast. The medication is increased gradually each week until therapeutic. The medication cannot be taken daily. Take the medication at the first sign of a headache.
The medication is increased gradually over 4 weeks. It is a medication to decrease the occurrence of migraines and is not taken at the beginning of a headache.
What is important for the nurse to teach the patient about sumatriptan (Imitrex)? The medication has a duration of 3 days. The medication starts to work within about 90 minutes. The medication is excreted via the GI tract. The medication causes vasodilation
The medication starts to work within about 90 minutes. The patient needs to know when to expect relief from the medication. It is important for the patient to know when it will start to work. The medication does not last for 3 days. It causes vasoconstriction, not dilation. The medication is not excreted via the GI tract.
Aura
subjective sensation that immediately precedes a migraine headache, consisting of a breeze, odor, or light
administration of the herb St. John's wort with triptans results in ____________
triptan toxicity.
Aura Phase Length S/S
~1 hour S/S: vision disturbances
What patient should not receive a nonsteroidal anti-inflammatory medication as ordered for migraine relief? The patient with a gastric ulcer The patient who drinks 10 cups of coffee a day The patient who has arthritis The patient who takes one aspirin per day for the prevention of heart disease
The patient with a gastric ulcer The patient with a gastric ulcer may have severe stomach upset and bleeding from the administration of an NSAID. The other patients are not at risk for taking these medications.
Which patient should receive a decreased dose of ergotamine? The patient who smokes two packs per day The patient who takes aspirin daily The patient who is taking a beta blocker for blood pressure The patient who takes Motrin every 6 hours
The patient who is taking a beta blocker for blood pressure Beta-adrenergic blockers increase the effect of ergotamine. The patient may need a decreased dose of the drug. Aspirin, Motrin, and smoking are not noted to increase the effect of ergotamine. Cola, coffee, tea, and grapefruit juice may increase the effect of ergotamine as well.
Which patient should not receive sumatriptan (Imitrex) as ordered? The patient with an elevated BUN The patient with a blood pressure of 140/95 mm Hg The patient with urinary output of 30 mL/hour The patient reporting nausea
The patient with an elevated BUN The patient with renal disease may have difficulty excreting the medication. An elevated BUN is an indication of renal disease. The patient with borderline hypertension should be assessed, but can receive the medication. Urinary output of 30 mL/hour is acceptable for adequate renal perfusion. Nausea often accompanies migraines and is not a contraindication for taking this medication.
What is essential for the nurse to assess prior to the patient taking sumatriptan-naproxen sodium (Treximet)? The patient's cardiac history If the patient is nauseous The patient's ability to administer an injection If the patient is able to eat with the medication
The patient's cardiac history The patient who takes Treximet has an increased risk of myocardial infarction. The medication is taken orally. Being nauseous is not a contraindication to taking this medication. The patient does not have to eat with the medication.
A patient is receiving chlorpromazine hydrochloride (Thorazine) for migraine headache. What will the nurse teach the patient about this therapy? This medication will increase photophobia. This medication will decrease anxiety. This medication is an antiemetic as well as a pain medication. This medication will increase alertness.
This medication is an antiemetic as well as a pain medication. This medication works as an antiemetic as well as decreasing pain in migraines. The medication may make the patient drowsy, and as investigators have shown can decrease photophobia.
Tension headache: Triggers (2) Pain quality Non-pharm Tx Pharm Tx
Triggers: tension, anxiety Pain: chronic contractions in scalp Non-pharm Tx: rest, relaxation techniques, or stress-reduction strategies Pharm Tx: acetaminophen, aspirin, NSAIDs
When is it permissible to give sumatriptan in combination with the MAO inhibitor.
Two weeks after an MAO inhibitor has been discontinued,
The nurse administers ergotamine tartrate (Ergot). What is the expected pharmacologic effect? Suppression of pain Drowsiness Vasoconstriction Diuresis
Vasoconstriction Ergotamine cases stimulation of cranial and peripheral vascular smooth muscles and constricts blood vessels to help abort a migraine. The expected effect is not drowsiness or diuresis. It does not mask or suppress pain. It should get rid of the cause of the migraine.
The nurse understands that the combination drug of acetaminophen, aspirin, and caffeine is contraindicated in a client who already takes which medication? Tetracycline Phenytoin Warfarin Digoxin
Warfarin Acetaminophen, aspirin, and caffeine would be contraindicated in clients who are currently taking warfarin because of the risk of bleeding with the combination of aspirin and warfarin.
A client is prescribed oral sumatriptan should be taught to expect symptom relief how soon after taking the drug? a) 60-90 minutes b) 30-60 minutes c) 2-3 hours d) 6-8 hours
a) 60-90 minutes
Naproxen has been prescribed to a client whose increasingly severe migraines are interfering with work performance and family life. When providing health education to this client, the nurse should instruct the client to consider what intervention? a) take the pills with a meal to minimize GI upset b) take them on an empty stomach first thing in the morning c) crush the pill and mix it into water or applesauce for any swallowing difficulties d) watch for constipation e) keep follow up appointments for bloodwork
a) take the pills with a meal to minimize GI upset Naproxen should be taken on a full stomach. The pills should not be crushed. Constipation is not a noted adverse effect and regular blood work is not warranted.
The combination of _____ , _____ , and ____ may be effective for the treatment of headaches.
acetaminophen, aspirin, caffeine
When teaching a client about the safe and effective use of ergotamine in the home setting, what instructions should the nurse provide? a) "Swallow the pill whole" b) "When you take this pill, place it under your tongue and let it dissolve completely." c) "Take the pill at the same time every day" d) "Monitor for urine discoloration or GI upset"
b) "When you take this pill, place it under your tongue and let it dissolve completely." Ergotamine is administered sublingual and is an abortive treatment that is not taken at the same time each day. It is not noted to discolor urine or cause GI upset.
An elderly client experiencing recurrent tension headaches reports taking an OTC combination of acetaminophen, ASA, and caffeine several times this week. The nurse should recognize that this combo medication may be contraindicated if the client has a history of what medical condition? a) renal impairment b) GI bleeding c) cardiac dysrhythmia d) hepatic impairment
b) GI bleeding ASA is contraindicated for patients who have history of GI bleeding.
NSAIDS:The most severe adverse effects of naproxen sodium include _____________ and ________
bronchospasm and anaphylaxis.
A client is prescribed sumatriptan as abortive therapy for migraines reports, "I took that pill about an hour and a half ago and I still don't feel any better. Can I take another?" How should the nurse respond?
c) "Wait at least half an hour before you take another pill." Administration of a second dose of the oral prep of sumatriptan when symptoms return is acceptable but not earlier than 2 hours after the first tab.
The nurse should teach the client prescribed chlorpromazine hydrochloride that this medication is likely to cause what reaction?
c) reduction of light sensitivity experienced during migraines Chlorpromazine hydrochloride has been shown to be effective in treating both the headache itself and the associated N/V. Investigators have also shown that antiemetic drugs decrease the photophobia and phonophobia that accompany the migraine headache.
When planning abortive therapy for a client who experiences migraines, what goal should the nurse prioritize? a) take abortive therapy drugs on a regularly scheduled basis b) identify and prevent causative factors c) the client will obtain rapid relief of migraine symptoms
c) the client will obtain rapid relief of migraine symptoms Abortive therapy is the administration of medications to treat the symptoms of migraine headaches. Drugs for abortive therapy are not taken on a regularly scheduled basis. Prevention and identification of causative factors are important, but these are not directly related to abortive therapy.
The combination of ergot-containing drugs and the triptans results in ______.
cardiac ischemia It is important to ask the patient about recent administration ergot alkaloids. The ergot alkaloids should not be given within 24 hours of the administration of triptans.
miosis
constricted pupils
A client has been prescribed naproxen for the treatment of migraines. The nurse who will administer the medication is aware of the black box warning that accompanies this drug will consequently prioritize what assessment? a) BUN and creatinine b) AST, ALK, and ALT c) Deep tendon reflexes d) heart rate and rhythm
d) heart rate and rhythm The FDA has issued a black box warning stating that naproxen sodium may put clients at increased risk for cardiovascular events and GI bleeding. Renal failure, liver failure, and reduced deep tendon reflexes are not the focus of this BBW.
A nurse is providing health education for a client who has recently received a diagnosis of migraines should convey what point? a) Avoid stress b) Taking herbal supplements c) Increase light exposure d) the importance of avoiding foods that may precipitate migraines
d) the importance of avoiding foods that may precipitate migraines Foods that precipitate migraine effects include aged cheeses, fermented foods, aspartame, monosodium glutamate, and chocolate. Stress is not a known salient causative factor. Herbal supplements and increased light exposure are unlikely to benefit.
ptosis
drooping eyelid
Menstrual migraine headache - pathology
migraine headache associated with a drop in circulating estrogen that occurs 2 to 3 days prior to the onset of menses
