Dihydroergotamine

INTRODUCTION

Indications

Vascular headaches, including Migraine, Cluster headaches.

Action

Vasoconstriction of dilated blood vessels by stimulating alpha-adrenergic and serotonergic (5-HT) receptors. Larger doses may produce alpha-adrenergic blockade and vasodilation. Therapeutic Effects: Constriction of dilated carotid artery bed with resolution of vascular headache.

Adverse Reactions/Side Effects

CNS: dizziness. EENT: rhinitis. CV: MYOCARDIAL INFARCTION, hypertension, angina pectoris, arterial spasm, intermittent claudication. GI: abdominal pain, nausea, vomiting, altered taste, diarrhea, polydipsia. MS: extremity stiffness, muscle pain, stiff neck, stiff shoulders. Neuro: leg weakness, numbness or tingling in fingers or toes. Misc: fatigue.

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 the frequency and severity of headaches, and document whether drug therapy is successful in decreasing migraine or cluster headache attacks.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

• Assess any muscle pain, stiffness, or weakness to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Be alert for sudden, intense leg pain during ambulation and other lower extremity exercises (intermittent claudication). Report the frequency and severity of these symptoms to the physician.

• Assess signs of numbness and tingling in the fingers and toes. Perform objective tests including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Watch for dizziness that affects gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• Because of the risk of MI and claudication, use extreme caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, respiration, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• 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.

Patient/Client-Related Instruction

• 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 ...