A patient complaining of headache with sensitivity to light, heat, and sound. Which drug is to be given?

NORCET 6 mains-2024

Pharmacology

Medium

Appeared in: NORCET 6 mains-2024

Explanation

The patient's symptoms (headache, photophobia, phonophobia) are hallmark features of a migraine attack.
Sumatriptan is a selective 5-HT1B/1D receptor agonist (a triptan), which is a first-line therapy for moderate to severe migraine attacks.
It works by constricting dilated cranial blood vessels and inhibiting the release of inflammatory neuropeptides, directly targeting the pathophysiology of a migraine.
Triptans are considered more specific and effective for aborting migraine attacks compared to simple analgesics.

Option A: Paracetamol is a simple analgesic. While it can be used as a first-line treatment for mild migraine attacks, it is often ineffective for moderate to severe migraines accompanied by significant sensory sensitivity.
Option C: Atropine is an anticholinergic agent. Its mechanism of action is unrelated to the pathophysiology of migraine headaches. It is used for conditions like symptomatic bradycardia or as an antidote for certain poisonings.
Option D: Domperidone is an antiemetic (anti-nausea) medication. It does not treat the headache itself but is often prescribed alongside migraine medication to manage the associated nausea and vomiting and to improve the absorption of oral drugs.

Visual 1: Diagram - Illustrating the mechanism of action of triptans. The visual should show a dilated cranial blood vessel during a migraine and how Sumatriptan binds to 5-HT1B/1D receptors to cause vasoconstriction and block pain signals.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pharmacological management of acute migraine headaches to guide bedside assessment, documentation, and the next nursing action.
Nurses must be able to recognize the classic symptoms of a migraine to facilitate prompt and appropriate treatment.
Patient education is a key nursing role, including teaching about migraine triggers (e.g., certain foods, stress, lack of sleep) and the correct use of abortive medications like Sumatriptan (i.e., take at the first sign of an attack).
It is crucial to assess for contraindications before administering triptans. They are contraindicated in patients with a history of ischemic heart disease, stroke, or uncontrolled hypertension due to their vasoconstrictive effects.

How to Approach the Question

First, analyze the patient's presenting symptoms: headache combined with sensitivity to light, heat, and sound.
Recognize this cluster of symptoms as the classic presentation of a migraine.
Next, review the drug options and recall their primary indications and mechanisms of action.
Evaluate each option's suitability for treating an acute migraine. Paracetamol is a general painkiller. Atropine is an anticholinergic. Domperidone is an anti-nausea drug.
Identify Sumatriptan as a member of the triptan class, which are specific abortive agents for migraine.
Conclude that Sumatriptan is the most specific and appropriate choice for the clinical scenario.

Concept Tested & Keywords

Concept Tested: Pharmacological management of acute migraine headaches.
Stem keywords: headache, sensitivity to light, sensitivity to heat, sensitivity to sound
Lead-in keywords: Which drug is to be given
Clinical cues: The combination of headache with photophobia and phonophobia is a classic presentation of a migraine.

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