Lehne's Migraine
The nurse is assessing a patient receiving dihydroergotamine [Migranal] for potential side effects. Which symptom, if found, would indicate a side effect of this drug?
Diarrhea
Abdominal pain and amylase 500 international units/L
Divalproex (tricyclic antidepressant)
are first-line drugs or abortive therapy of moderate to severe migraine
triptans (sumatriptan)
is indicated for migraineurs who have frequent attacks (one or two a month), especially severe attacks, or attacks that do not respond adequately to abortive agents
prophylactic therapy
A patient is prescribed propranolol for migraine prevention. Which assessment finding would be a priority to report to the prescriber?
Expiratory wheezing
What can estrogen supplements help prevent?
menstrual-associated migraine
A patient is prescribed ergotamine tartrate (Ergomar) for migraine headaches. Which statement made by the patient indicates a need for further teaching?
"I am not at risk for physical dependence for this drug."
The nurse is teaching a patient with a new prescription for ergotamine [Ergomar]. Which statement is most appropriate to include in the teaching plan?
"You should not use this drug more than 1 or 2 days per week."
Why should pregnant women avoid taking ergotamine?
-It can cause uterine contractions, leading to premature birth and abortion -Pregnancy Risk Category X
Which drugs should triptans not be combined with and why?
-should not be combined with another triptan or with ergot derivatives -because it can cause excessive vasoconstriction -should not be combined with SSRIs or SNRIs because serotonin syndrome could occur
A patient receiving lithium carbonate for prevention of cluster headaches. This drug has a narrow therapeutic index. Which drug level would fall into the safe and effective range?
0.8 mEq/L
The healthcare provider orders sumatriptan 50 mg PO every 12 hours PRN. The drug available is sumatriptan 25-mg tablets. How many tablets will the nurse administer?
2 tablets
Which over-the-counter medication has not demonstrated effectiveness in relieving mild to moderate migraine headache pain?
Acetaminophen
A nurse is reviewing the health history of a cleint who has migraine headaches and is to begin prophylaxis therapy with propranolol. Which of the following findings in the client history should the nurse report to the provider?
An ECG indicates a first-degree heart block
The nurse has administered sumatriptan (Imitrex) subcutaneously for migraine headahce relief at 2100 (9PM) to a 35-year old smoker. One hour after administration, the patient complains of heavy arms and chest pressure. What is the priority action at this point?
Assess vital signs and evaluate the chest pain
Which of the following measurements would prompt the nurse to hold the sumatriptan dose and contact the provider?
Blood pressure 190/100
Potassium 5.6 mEq/L
Candesartan (ARB)
Which assessment finding would be of greatest priority to report to the prescriber if the nurse was preparing to administer ergotamine to a patient who is experiencing the start of a migraine headache?
Capillary refill of 12 seconds
The nurse would consult the prescriber before administering ergotamine or triptan drugs for migraine headache to a patient with which conditions?
Cardiovascular disease Hypertension
Occur in a series or "cluster" of attacks Each attack lasts 15 minutes to 2 hours Severe, throbbing, unilateral pain near the eye Lacrimation, conjunctival redness, nasal congestion, rhinorrhea, ptosis, and miosis on the same side of the headache One or two attacks every day for 2 to 3 months An attack-free interval of months to years separates clusters
Cluster headaches
A patient does not inform her primary care provider (PCP) that she is prescribed duloxetine (Cymbalta) by her rheumatologist. The PCP prescribes a triptan for migraines. What symptoms of serotonin syndrome are possible with this combination?
Confusion and incoordination
Agonist activity at subtypes of serotonin receptors, specifically 5-HT1B and 5-HT1D receptors Suppresses release of CGRP to block inflammation associated with the trigeminal vascular system Toxicity: Ergotism
Ergot alkaloids: Ergotamine
is a second-line drug for abortive therapy of severe migraine
Ergotamine
Positive Homan's sign and swelling in left calf
Estrogen (hormone)
A nurse is providing teaching to a client who is experiencing migraine headaches. Which of the following instructions should the nurse provide?
Identify and avoid trigger factors Lie down in a dark quiet room at the onset of a migraine Avoid foods that contain tyramine
The physician prescribes propranolol [Inderal] for a patient with migraine headaches. It is most important for the nurse to do what?
Instruct the patient that the medication will prevent migraines
Why should ergotamine not be combined with potent inhibitors of CYP3A4?
It creates a risk of intense vasoconstriction and associated ischemia
Why should ergotamine not be taken routinely?
It has a high risk for physical dependence
The nurse is caring for a female patient receiving sumatriptan [Imitrex]. Which concept guides the nursing care of this patient?
Many patients experience symptoms of chest pressure or heavy arms.
What is the primary reason why abortive medication for migraine headaches should not be used more than 1 or 2 days a week?
Medication-overuse headache
Throbbing head pain of moderate to severe intensity Nausea and vomiting Sensitivity to light and sound Highly debilitating Hormonal component Family history is typical Primary forms Neurovascular disorder that involves the dilation and inflammation of intracranial blood vessels
Migraine Headaches
serotonin1B/1D receptor agonists
Naratriptan [Amerge] Rizatriptan [Maxalt] Zolmitriptan [Zomig] Almotriptan [Axert] Frovatriptan [Frova] Eletriptan [Relpax]
The nurse is preparing to give ergotamine [Ergomar]. This agent is effective against headaches of which origin?
No identifiable cause
What are some treatment options for a tension-type headache?
Nonopioid analgesics: Acetaminophen Nonsteroidal anti-inflammatory drugs: Aspirin, ibuprofen, and naproxen Analgesic-sedative combination: Aspirin and butalbital Patient teaching about how to manage stress
An emergency department patient reports that she took frovatriptan 2.5 mg at home an hour ago but still has a migraine. Which action should the nurse take next?
Notify the healthcare provider.
An adult patient presents to the emergency department and is diagnosed with a severe migraine headache. Which class of medication would the nurse expect to be ordered for this patient?
Opioid analgesic Migraine-specific agent Antiemetic
Second-line drug for terminating a migraine attack Can cause diarrhea
Parenteral dihydroergotamine [D.H.E. 45, Migranal]
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?
Positive home pregnancy test Numbness and tingling in fingers Muscle pain
Which nursing concern would be of greatest priority when a patient is prescribed meperidine (Demerol) for migraine headaches?
Potential for respiratory distress
What are some treatment options for a cluster headache?
Primary therapy directed at prophylaxis Glucocorticoids (prednisone and dexamethasone) Verapamil Lithium
Preferred drugs for migraine prophylaxis
Propranolol Divalproex Amitriptyline
Apical pulse 48 beats/min
Propranolol (beta blocker)
The nurse is reviewing the patient's current medication list and recognizes that which medication is considered a first-line drug for migraine prevention?
Propranolol [Inderal]
The nurse would plan for which potential nursing problem when administering haloperidol (Haldol) for migraine headache?
Safety
Name some emotions that can trigger a migraine headache.
Stress Anticipation Anxiety Depression Excitement Frustration
Examples of abortive agents
Sumatriptan and naproxen Haloperidol [Haldol]
Most common form of headache Moderate, nonthrobbing pain Usually located in a "headband" distribution May be episodic or chronic
Tension-type headache
The nurse is reviewing the medication orders for a patient on sumatriptan and sertraline [Zoloft]. The nurse notes which of the following possible interactions between these medications?
The combined medications can cause serotonin syndrome.
The nurse is caring for a patient with migraine headaches. Which assessment best indicates that sumatriptan (Imitrex) is exerting the desired therapeutic affect?
The patient reports the termination of the migraine headaches after the drug is administered
What is true about triptan therapy for migraine headaches?
Therapy relieves headache, nausea, and sensitivity to sound and light
A nurse knows the following about migraine headaches:
They involve inflammation of intracranial blood vessels Their therapy includes regular schedule for eating, sleep, and exercise Their therapy should start at the earliest sign of attack
What would be a contraindication for estrogen use to prevent menstrual migraines?
Thrombophlebitis
How are drugs for migraines used?
To abort an ongoing attack To prevent attacks from occurring
pH 7.32; HCO3 19 mEq/L; pco2 35 mm Hg
Topiramate (antiseizure)
Name foods/beverages that can trigger a migraine headache.
Tyramine Nitrates Phenylethylamine Monosodium glutamate Aspartame Yellow food coloring Alcohol Caffeine (excessive use or withdrawal)
Systolic BP drops 30 mm Hg when changing from sitting to standing
Verapamil (CCB)
Name 2 ways antimigraine drugs are used.
abortive and prophylactic
are effective for abortive therapy of mild to moderate migraine
aspirin-like analgesics (acetaminophen, aspirin, naproxen)
Adverse effects/contraindications of triptans
can cause coronary vasospasm -contraindicated for patients with ischemic heart disease, prior MI, or uncontrolled hypertension
The rationale for administering both ergotamine and metoclopramide (Reglan) to a patient to abort a migraine headache includes that the metoclopramide:
decreases nausea and vomiting
neurovascular disorder involving dilation and inflammation of intracranial arteries
migraine
What are the 2 kinds of drugs for abortive therapy?
non-migraine-specific analgesics (aspirin-like drugs and opioids) migraine-specific drugs (triptans and ergot alkaloids)
are reserved for severe migraine that has not responded to other drugs
opioid analgesics (butorphanol, meperidine)
What forms of drugs are triptans available?
oral formulations-slow onset -sumatriptan and zolmitriptan are available in fast-acting formulations (either nasal spray, subQ injection, or both)
How do triptan drugs work?
they activate 5-HT 1B/1D receptors and thereby constrict intracranial blood vessels and suppress release of inflammatory neuropeptides
What is the goal of abortive therapy?
to eliminate headache pain and associated nausea and vomiting
What is the goal of prophylactic therapy?
to reduce the incidence and intensity of migraine attacks
What are the signs of an ergotamine overdose?
will cause ergotism- severe tissue ischemia secondary to generalized constriction of peripheral arteries
