Sumatriptan

INTRODUCTION

Indications

Acute treatment of migraine attacks. SC: Acute treatment of cluster headache episodes.

Action

Acts as a selective agonist of 5-HT₁ at specific vascular serotonin receptor sites, causing vasoconstriction in large intracranial arteries. Therapeutic Effects: Relief of acute attacks of migraine.

Adverse Reactions/Side Effects

All adverse reactions are less common after oral administration

CNS: dizziness, vertigo, anxiety, drowsiness, fatigue, feeling of heaviness, feeling of tightness, headache, malaise, strange feeling, tight feeling in head, weakness. EENT: alterations in vision, nasal sinus discomfort, throat discomfort. CV: MI, angina, chest pressure, chest tightness, coronary vasospasm, ECG changes, transient hypertension. GI: abdominal discomfort, dysphagia. Derm: tingling, warm sensation, burning sensation, cool sensation, flushing. Local: injection-site reaction. MS: jaw discomfort, muscle cramps, myalgia, neck pain, neck stiffness. Neuro: numbness.

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 or cluster headache attacks.

• Assess any muscle pain, cramps, jaw discomfort, or neck pain and stiffness 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.

• Monitor excessive drowsiness, anxiety, or strange sensations such as tightness or heaviness. Notify physician if these symptoms become problematic.

• Watch for dizziness and vertigo 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.

• Monitor SC injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• 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. ...