Naratriptan

INTRODUCTION

Indications

Acute treatment of migraine headache.

Action

Acts as an agonist at specific 5-HT₁ receptor sites in intracranial blood vessels and sensory trigeminal nerves. Therapeutic Effects: Cranial vessel vasoconstriction with resultant decrease in migraine headache.

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness, malaise/fatigue. CV: CORONARY ARTERY VASOSPASM, MI, VENTRICULAR FIBRILLATION, VENTRICULAR TACHYCARDIA, myocardial ischemia. GI: nausea. Neuro: paresthesia. Misc: pain/pressure sensation in throat/neck.

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 the intensity of migraine attacks.

• Watch for dizziness 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.

• Assess any neck or throat pain and pressure 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.

Interventions

• Because of the risk of MI and ventricular 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. Help patient also explore other nonpharmacologic methods to reduce chronic headache pain, such as relaxation techniques, imagery, and so forth.

• If a headache occurs and drug treatment is needed during a rehabilitation session, allow patient to recover in a quiet, darkened room to allow the drug to achieve maximal effects.

Patient/Client-Related Instruction

• Advise patient and family or caregiver about the signs of MI (see above under Examination and Evaluation), and to seek immediate medical assistance if these signs develop.

• Advise the patient to bring this drug to each therapy session; this drug is most effective when taken at the first signs of a migraine attack.

• Advise patient ...