Therapeutic: vascular headache suppressants
Pharmacologic: 5-HT1 agonists
Acute treatment of migraine headache.
Acts as an agonist at specific 5-HT receptor sites in intracranial blood vessels and sensory trigeminal nerves. Therapeutic Effects: Cranial vessel vasoconstriction with associated decrease in release of neuropeptides and resultant decrease in migraine headache.
Adverse Reactions/Side Effects
CNS: dizziness, drowsiness, fatigue. CV: CORONARY ARTERY VASOSPASM, MI, VENTRICULAR FIBRILLATION, VENTRICULAR TACHYCARDIA, chest pain, myocardial ischemia. GI: dry mouth, dyspepsia, nausea. Derm: flushing. MS: skeletal pain. Neuro: paresthesia. Misc: pain.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Continually monitor for signs of coronary artery vasospasm and MI, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea. Seek immediate medical assistance if patient develops these signs.
Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, dizziness, fainting, and fatigue/weakness.
Assess the frequency and severity of headaches, and document whether drug therapy is successful in decreasing migraine attacks.
Assess any skeletal or muscle pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.
Assess signs of paresthesia (numbness, tingling). Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.
Watch for dizziness and drowsiness that affects gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.
Because of the risk of MI and arrhythmias, use extreme caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, respiration, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).
Implement appropriate interventions (manual techniques, physical agents, therapeutic exercise) to manage headache pain and reduce the need for drug therapy. Help patient also explore other nonpharmacologic methods to reduce chronic headache pain (relaxation techniques, imagery, and so forth).
If a headache occurs and drug treatment is needed during a rehabilitation session, allow patient to recover in a quiet, darkened room to allow the drug to achieve maximal effects.
Advise patient and family or caregiver about the signs of MI (see above under Examination and Evaluation), and to seek immediate medical assistance if these signs develop.
Advise the patient to bring this drug to each therapy session; this drug is most effective when taken at the first signs of a ...