A client arrives at the emergency department with a severe, debilitating migraine headache. The nurse anticipates administering which of the following medications for an acute migraine attack?

Metoclopramide (Reglan) is often used in the emergency department for acute migraine attacks, particularly when accompanied by nausea and vomiting. It helps relieve gastrointestinal symptoms and can enhance the absorption of co-administered analgesics. It may also have direct anti-migraine benefits due to dopamine receptor antagonism.

Rationale for correct answer:
4. Metoclopramide (Reglan): Effective for acute migraine management, especially when nausea or vomiting limits oral medication absorption. Often given IV along with other acute migraine treatments such as NSAIDs or triptans.

Rationale for incorrect answers:

1. Divalproex sodium (Depakote): Used for migraine prophylaxis, not acute attacks.
2. Topiramate (Topamax): An anticonvulsant used for migraine prevention, not for immediate symptom relief.
3. Propranolol (Inderal): A beta-blocker for migraine prophylaxis, not acute treatment.

Take home points

• Acute migraine therapy targets immediate symptom relief and often combines antiemetics with analgesics or triptans.
• Preventive medications (Depakote, Topamax, propranolol) are not effective for aborting ongoing attacks.
• IV metoclopramide can be a first-line choice in the ED, especially with significant nausea or vomiting.

Chronic tension-type headaches are often associated with muscle tension, stress, and poor posture. Non-pharmacological interventions aim to reduce muscle tightness and stress, and improve coping strategies. Evidence-based approaches such as acupuncture, relaxation training, and biofeedback have been shown to help reduce headache frequency and severity.

Rationale for correct answers:

1. Acupuncture: Stimulates specific points in the body to help reduce headache frequency and intensity; may benefit some clients with tension-type headaches.
2. Relaxation training: Techniques like progressive muscle relaxation and deep breathing reduce stress and muscle tension, helping prevent headache onset.
3. Biofeedback: Teaches clients to monitor and control muscle tension and other physiological processes to reduce headache occurrence.

Rationale for incorrect answers:
4. Feverfew supplements: Primarily used for migraine prevention; limited evidence supports its use for tension-type headaches.
5. Botox injections: Approved for chronic migraine prevention, not indicated for tension-type headaches.

Take home points

• Stress management strategies are a cornerstone of tension-type headache treatment.
• Acupuncture, relaxation training, and biofeedback are safe and effective non-drug interventions.
• Supplements and Botox are better suited for other headache types, particularly migraines.