Migraine & Triptans

Migraine is a recurrent, often unilateral, throbbing headache lasting 4 to 72 hours, with nausea, vomiting, photophobia and phonophobia. Aura, such as flashing lights, visual loss or tingling, comes before the pain in about a quarter of clients, and a headache diary identifies triggers such as stress, sleep change, skipped meals and hormonal shifts. During an attack the client needs a dark, quiet room, a cold compress and treatment at the first sign of pain. Triptans such as sumatriptan treat an attack at onset but are contraindicated with coronary artery disease, prior MI, stroke or TIA, and uncontrolled hypertension, and are never given within 24 hours of another triptan or an ergot. Frequent acute-drug use causes medication-overuse headache, so the client limits acute medication days as directed. A sudden "worst headache of my life," fever with stiff neck, new neurologic deficit, headache after head injury or a new headache in an older adult is an emergency.