Ergotamine

INTRODUCTION

Indications

Treatment of vascular headaches, including Migraine with or without aura, 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. CV: MYOCARDIAL INFARCTION, hypertension, angina pectoris, arterial spasm, intermittent claudication. GI: abdominal pain, nausea, vomiting, 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 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).

• Monitor any chest pain (angina pectoris) or transient leg pain and cramping that occurs when walking (intermittent claudication). Document the frequency and severity of chest or leg pain and report these findings to the physician.

• Assess any leg weakness or coldness and numbness in the fingers and toes. Document peripheral blood flow and skin temperature whenever possible to determine if these symptoms are caused by peripheral vasoconstriction. Report these findings to the physician.

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

• Assess dizziness that might affect 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, use extreme caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, 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.

Patient/Client-Related Instruction