Pharmacology · chapter 12 · Anticonvulsant Drugs and Drugs to Treat Epilepsy, Migraine Headaches, and Intracranial Emergencies
Migraine Headaches and Migraine Headache Drugs
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.
Key points
How long a migraine lasts
Migraine headaches can last for several hours up to several days and can be debilitating, often interfering with daily activities.
Common migraine triggers
Migraines can stem from a range of factors, which may include environmental, potent odors, tobacco use, motion sickness, hormonal fluctuations, flashing lights, inadequate sleep, heightened stress levels, and certain foods such as aged cheeses, aspartame, and monosodium glutamate (MSG), and caffeine withdrawal (American Migraine Foundation, 2023; National Institute of Neurological Disorders and Stroke, 2023).
What may cause the pain
The underlying pathophysiology of migraine headaches is unclear, but a comprehensive theory proposes the involvement of neuronal hyperexcitability, vasodilation of blood vessels—which triggers pain receptors—and inflammation in the brain (American Migraine Foundation, 2023).
Imaging rules out other causes
Radiologic imaging, such as an MRI or CT scan, may also be performed to rule out other potential causes of the headaches, such as brain tumors, meningitis, or ischemia (American Migraine Foundation, 2023).
Abortive versus preventive therapy
Abortive therapy aims to relieve the symptoms of a migraine headache through drug administration. On the other hand, preventive therapy involves the use of drugs to prevent the occurrence of migraine headaches altogether.
How triptans work
By selectively binding to serotonin receptors 5-HT 1B and 5-HT 1D, triptans induce vasoconstriction of cranial arteries that are typically dilated during migraines.
Triptan adverse effects
Adverse effects of triptans include dizziness, nausea, flushing, tingling, neck pain, chest tightness, and paresthesia.
Who should not take triptans
Triptans are contraindicated in clients with a history of myocardial infarction, coronary artery disease, stroke, uncontrolled hypertension, and peripheral vascular disease (Nicholas Nicholas, 2023).
Sumatriptan boxed warning
There is cardiovascular risk from sumatriptan with an increased risk of adverse thrombotic events, including myocardial infarction and stroke.
Ergot alkaloid contraindications
Ergot alkaloids are contraindicated in hypersensitivity to the drug or any of its components, peripheral vascular disease, coronary heart disease, hypertension, impaired hepatic or renal function, and sepsis.
Ergotamine with CYP3A4 inhibitors
Ergotamine is contraindicated with potent inhibitors CYP3A4 drugs. Concomitant use of these drugs may result in serious vasospasm producing cerebral limb ischemia.
Serotonin receptor agonist adverse effects
Adverse effects include paresthesia, fatigue, drowsiness, nausea, vomiting, muscle weakness, and hypertension.
How CGRP receptor antagonists work
They block CGRP receptors and inhibit the biological activity of CGRP neuropeptides. Adverse effects include nausea, rash, and dyspnea.
Report worsening symptoms at once
Report worsening of symptoms such as visual changes and uncontrolled head pain to the health care provider immediately because these manifestations can be debilitating.
Terms to know
- aura
- Some people may experience a warning symptom, known as an aura, which can include visual disturbances such as flashing lights or blind spots.
- Triptans
- Triptans are serotonin agonists that target the pathophysiological mechanism of migraine headaches, effectively eliminating symptoms.
- Ergot alkaloids
- Ergot alkaloids are alpha-adrenergic blockers, a class of drug that directly stimulates vascular smooth muscle, thereby causing vasoconstriction.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
A client newly prescribed sumatriptan asks how the drug relieves a migraine. Which explanation by the nurse is accurate?
- It prevents migraines from ever starting when taken daily.
- It blocks pain signals in the spinal cord.
- It narrows the cranial arteries that dilate during a migraine.
- It relaxes tight neck muscles.
Answer: It narrows the cranial arteries that dilate during a migraine.
Triptans bind serotonin 5-HT1B and 5-HT1D receptors and cause vasoconstriction of cranial arteries that are dilated during migraines. The section does not describe spinal pain blocking or muscle relaxation, and triptans are used to relieve symptoms rather than as daily prevention.
A client asks for sumatriptan for a migraine. Which findings in the client's history should make the nurse question the order? Select all that apply.
- Coronary artery disease
- Uncontrolled hypertension
- Seasonal allergies
- Migraine with aura
- Previous stroke
Answer: Coronary artery disease, Uncontrolled hypertension, Previous stroke
Triptans are contraindicated with a history of myocardial infarction, coronary artery disease, stroke, uncontrolled hypertension and peripheral vascular disease, and sumatriptan carries a boxed warning for thrombotic events. Seasonal allergies and an aura are not listed contraindications.
A client is admitted with a severe migraine. Which action by the nurse best supports the client's comfort?
- Turn on the television to distract the client.
- Open the blinds to let in daylight.
- Keep the room dark, calm and quiet.
- Encourage visitors to sit with the client.
Answer: Keep the room dark, calm and quiet.
Nursing care for clients on migraine drugs includes maintaining a dark, calm and quiet environment. Light, visitors and noise work against that, and flashing lights are listed among migraine triggers.
A nurse is helping a client with migraines identify possible triggers. Which items should the nurse mention? Select all that apply.
- Caffeine withdrawal
- Drinking water with meals
- Heightened stress
- Inadequate sleep
- Aged cheeses
Answer: Caffeine withdrawal, Heightened stress, Inadequate sleep, Aged cheeses
The listed triggers include certain foods such as aged cheeses, inadequate sleep, heightened stress and caffeine withdrawal. Drinking water is not named as a trigger.
A client who takes ergotamine for migraines is prescribed a potent CYP3A4 inhibitor. What complication concerns the nurse most?
- Low blood glucose
- Weight gain
- Serious vasospasm causing ischemia
- Loss of the drug's effect
Answer: Serious vasospasm causing ischemia
Ergotamine carries a boxed warning: it is contraindicated with potent CYP3A4 inhibitors because the combination may cause serious vasospasm and ischemia. The other effects are not described for this interaction.
A client who takes a selective serotonin reuptake inhibitor for depression is prescribed lasmiditan for migraines. What should the nurse monitor for?
- Hypoglycemia
- Serotonin syndrome
- Hearing loss
- Gingival hyperplasia
Answer: Serotonin syndrome
Lasmiditan given with other drugs associated with serotonin syndrome, such as SSRIs, can cause serotonin syndrome, so the client is monitored closely. The other options are not effects described for lasmiditan.
Where every quote comes from
Section 12.2 Migraine Headaches and Migraine Headache Drugs of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.