Question 1

A patient arrives in the emergency department complaining of numbness in the extremities. The nurse notes that the patient's hands and feet are cool and pale. When conducting a health history, the nurse learns that the patient has a history of migraine headaches. The nurse recognizes this patient's symptoms as:

A) ergotamine withdrawal.
B) ergotism.
C) severe migraine symptoms.
D) sumatriptan side effects.

ergotism.

Accepted Answer

Ergotism is a serious toxicity caused by acute or chronic overdose of ergotamine. The toxicity results in ischemia, causing the extremities to become cold, pale, and numb. Symptoms associated with ergotamine withdrawal include headache, nausea, vomiting, and restlessness. These are not symptoms of a severe migraine or side effects of sumatriptan.

Question 2

A patient who has occasional migraine headaches tells a nurse that the abortive medication works well, but she would like to do more to prevent the occurrence of these headaches. The nurse will suggest that the patient:

A) ask the provider about an adjunct medication, such as prochlorperazine.
B) discuss the use of prophylactic medications with the provider.
C) keep a headache diary to help determine possible triggers.
D) take the abortive medication regularly instead of PRN.

Accepted Answer

Keeping a headache diary to try to identify triggers to migraines can be helpful when a patient is trying to prevent them and is the first step in managing headaches. Prochlorperazine is an antiemetic and does not prevent or abort migraine headaches. Prophylactic medications are used when headaches are more frequent. To prevent medication overuse headache, abortive medications should not be used more than 1 to 2 days at a time.

Question 3

A patient who has a history of asthma experiences three or four migraine headaches each month. The patient uses sumatriptan (Imitrex) as an abortive medication and has developed medication overuse headaches. The patient asks the nurse what can be done to prevent migraines. The nurse will suggest that the patient discuss which preventive medication with the provider?

A) Botulinum toxin
B) Meperidine (Demerol)
C) Timolol
D) Topiramate (Topamax)

Topiramate (Topamax)

Accepted Answer

Topiramate can be used for migraine prophylaxis, and its benefits appear equal to those of the first line beta blockers. Botulinum toxin can be used for migraine prophylaxis in patients who have 15 or more headaches a month. Meperidine may be used as abortive therapy but has addictive potential. Timolol is a beta blocker; this patient has asthma, and because beta blockers cause bronchoconstriction, these agents are not recommended.

Question 4

A patient who uses ergotamine (Ergomar) to abort migraine headaches reports nausea and vomiting with the headaches. What will the nurse tell the patient?&#10;A) &#34;Ask your provider about using another antimigraine medication.&#34;&#10;B) &#34;Nausea and vomiting are signs of ergotamine toxicity.&#34;&#10;C) &#34;These symptoms occur with migraine headaches and will diminish over time.&#34;&#10;D) &#34;You should talk to your provider about an adjunct antiemetic medication.&#34;

Accepted Answer

Nausea and vomiting, which occur with migraines, can increase with ergotamine use, because the drug can stimulate the chemoreceptor trigger zone. Patients should be treated with metoclopramide or a phenothiazine antiemetic. It is not necessary to change antimigraine medications at this time. Nausea and vomiting do not indicate ergotamine toxicity. These symptoms will not diminish over time.

Question 5

A young woman with migraine headaches who has recently begun taking sumatriptan (Imitrex) calls the nurse to report a sensation of chest and arm heaviness. The nurse questions the patient and determines that she feels pressure and not pain. What will the nurse do?

A) Ask the patient about any history of hypertension or coronary artery disease.
B) Determine whether the patient might be pregnant.
C) Reassure the patient that this is a transient, reversible side effect of sumatriptan.
D) Tell the patient to stop taking the medication immediately.

Accepted Answer

Some patients taking sumatriptan experience unpleasant chest symptoms, usually described as "heavy arms" or "chest pressure." These symptoms are transient and are not related to heart disease. Patients experiencing angina-like pain when taking sumatriptan, as a result of coronary vasospasm, should be asked about hypertension or coronary artery disease (CAD); they should not take sumatriptan if they have a history of either of these. The symptoms this patient describes are not characteristic of pregnancy. There is no need to stop taking the medication.

Question 6

A prescriber orders sumatriptan (Imitrex) for a patient for a migraine headache. Before administration of this drug, it would be important for the nurse to assess whether the patient:&#10;A) has a family history of migraines.&#10;B) has taken acetaminophen in the past 3 hours.&#10;C) has taken ergotamine in the past 24 hours.&#10;D) is allergic to sulfa compounds.

Accepted Answer

Sumatriptan, other triptans, and ergot alkaloids all cause vasoconstriction and should not be combined, or excessive and prolonged vasospasm could result. Sumatriptan should not be used within 24 hours of an ergot derivative and another triptan. A family history is important, but it is not vital assessment data as it relates to this scenario. Acetaminophen has no drug-to-drug interaction with sumatriptan. Sulfa is not a component of sumatriptan and therefore is not relevant.

Question 7

A woman with moderate migraine headaches asks a nurse why the provider has ordered metoclopramide (Reglan) as an adjunct to aspirin therapy, because she does not usually experience nausea and vomiting with her migraines. The nurse will tell her that the metoclopramide is used to:

A) help induce sleep.
B) improve absorption of the aspirin.
C) prevent gastric irritation caused by the aspirin.
D) prolong the effects of the aspirin.

Accepted Answer

Besides reducing nausea and vomiting, metoclopramide also reverses gastric stasis and improves absorption of oral antimigraine drugs. It is not used to induce sleep. It does not prevent gastric irritation or prolong the effects of the aspirin.

Question 8

Supplemental oxygen has been shown to help reduce symptoms for which type of headache?&#10;A) Cluster&#10;B) Menstrual migraine&#10;C) Migraine&#10;D) Tension-type

Accepted Answer

Cluster headaches can be treated with 100% oxygen inhalation. Oxygen therapy is not used to treat other types of headaches.

Question 9

A patient is being treated for an infection with erythromycin. The nurse obtains a health history and learns that the patient has migraine headaches. The nurse will tell the patient to avoid which medication while taking the erythromycin?

A) Acetaminophen
B) Ergotamine (Ergomar)
C) Sumatriptan (Imitrex)
D) Topiramate

Accepted Answer

Macrolide antibiotics, such as erythromycin, are potent inhibitors of CYP3A4; these drugs can raise ergotamine to dangerous levels, so this combination should be avoided. It is safe to take acetaminophen, sumatriptan, and topiramate with erythromycin.

Question 10

A patient on the unit complains of cluster headaches. A new graduate nurse is asked to differentiate between a migraine headache and cluster headaches. The graduate nurse is correct to state that manifestations and/or risk factors for a patient with cluster headaches include what? (Select all that apply.)

A) Female gender
B) Male gender
C) Complaints of nausea and vomiting
D) Short duration (15 minutes to 2 hours)
E) Auras before the onset of headache pain
F) Throbbing, sometimes piercing pain

Accepted Answer

Cluster headaches are more common in males, are short in duration, and present as throbbing and piercing pain. Migraine headaches are more common in females and are manifested by nausea and vomiting and the presence of an aura before the onset of headache pain.

Deck 30: Drugs for Headache