Migraine Headaches

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Jane is a 67-year-old woman with a history of mild hypertension and classic angina pectoris. She is seeking treatment for migraine headaches of moderate intensity. Her headaches are preceded by bilateral light flashes and dizziness that last about 10 minutes prior to the onset of pain. Her headaches are also frequently accompanied by photophobia, severe nausea, and occasional vomiting.
What medication would be contraindicated for acute treatment of Jane's headaches?
-Acetaminophen
-Aspirin
-Caffeine
-Propranolol
-Sumatriptan

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Terms in this set (5)

Sumatriptan.
Sumatriptan is a serotoninergic agonist that could produce vasoconstriction and is, therefore, contraindicated in patients with a history of ischemic heart disease (as well as other peripheral vascular diseases, or pregnancy).

When trying to provide relief for Jane's nausea, you face the dilemma that she might not be able to keep anything down if taken orally. You, therefore, decide to give her an intramuscular injection of diphenhydramine (Benadryl) and write her a prescription for a drug with a similar mechanism of action that is available in a suppository formulation.

You prescribe which of the following?
-Ergotamine
-Ketorolac
-Morphine
-Promethazine
-Rizatriptan

Promethazine.
This is a drug with anti-emetic properties that block H1 receptors (as well as weak antagonism of dopamine receptors). It is available in a rectal suppository formulation that is useful when the patient is likely to regurgitate any drug given orally before it can be absorbed.

Which of the following is a D2 dopaminergic antagonist that has 5 black box warnings, but is nevertheless used for its antiemetic properties in the treatment of migraine headaches.
-Amitriptyline
-Cyproheptadine
-Methysergide
-Metoclopramide
-Topiramate

Metoclopramide.
Metoclopramide and other drugs with similar D2 receptor antagonist effects in the chemoreceptor trigger zone are frequently used in emergency department settings to treat migraines. Other examples include the antipsychotics chlorpromazine and prochlorperazine. Diphenhydramine is often coadministered to prevent akathisia and dystonic reactions produced by these drugs.

A 17-year-old high school athlete with a history of asthma comes to your clinic seeking a preventative medication for migraine headaches. Which of the following would be contraindicated?
-Amitriptyline
-Propranolol
-Topiramate
-Valproate

Propranolol.
Propranolol is contraindicated in patients with asthma.

A 23-year-old woman with a history of depression comes to your clinic seeking relief for a severe migraine headache that began 20 minutes ago. She is currently taking the SSRI citalopram for her depression and an estrogen/progesterone combined oral contraceptive.
What medication would you avoid using for her acute treatment?
-Ergotamine
-Morphine
-Sumatriptan
-Topiramate

Sumatriptan.
SSRIs and triptans are different classes of medications that both elevate serotonin levels, and when combined they can "potentially" cause a serotonin syndrome which can produce hypertension, tachycardia, and hyperthermia. Its best to avoid combining two serotonergic drugs whenever possible.