Pharmacologic Profile

General Use

Used for acute treatment of vascular headaches (migraine, cluster headaches, migraine variants). Other agents such as some beta blockers and some calcium channel blockers are used for suppression of frequently occurring vascular headaches.

General Action and Information

Ergot derivatives (ergotamine, dihydroergotamine) directly stimulate alpha-adrenergic and serotonergic receptors, producing vascular smooth muscle vasoconstriction. Almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan produce vasoconstriction by acting as serotonin (5-HT₁) agonists.

Contraindications

Avoid using these agents in patients with ischemic cardiovascular disease.

Precautions

Use cautiously in patients who have a history of, or at risk for, cardiovascular disease.

Interactions

Avoid concurrent use of ergot derivative agents with serotonin agonist agents; see also individual agents.

Nursing Implications

Assessment

• Assess pain location, intensity, duration, and associated symptoms (photophobia, phonophobia, nausea, vomiting) during migraine attack and frequency of attacks.

Potential Nursing Diagnoses

• Acute pain (Indications)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)

Implementation

• Medication should be administered at the first sign of a headache.

Patient/Family Teaching

• Inform patient that medication should be used only during a migraine attack. It is meant to be used for relief of migraine attacks but not to prevent or reduce the number of attacks.
• Advise patient that lying down in a darkened room following medication administration may further help relieve headache.
• May cause dizziness or drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
• Advise patient to avoid alcohol, which aggravates headaches.

Evaluation/Desired Outcomes

• Relief of migraine attack.