A nurse is teaching a client about preventative medications for frequent migraine headaches. Which of the following drug classes are commonly used for prophylaxis? Select all that apply

Sumatriptan is used for the acute treatment of migraine attacks and is most effective when taken at the first sign of symptoms. It is not for daily preventive use and should not be taken with serotonergic supplements like St. John’s Wort. The tablet form should be swallowed whole unless otherwise directed by the manufacturer.

Rationale for correct answer:
2. "This medication should be taken at the first sign of a migraine headache.": Early administration increases its ability to stop the migraine before it becomes severe.

Rationale for incorrect answers:

1. "You should take this medication daily to prevent headaches from occurring.": Daily use is not recommended; it increases the risk of rebound headaches.

3. "This medication can be safely used with St. John's Wort to enhance its effects.": This combination increases the risk of serotonin syndrome, which can be life-threatening.

4. "You may crush or chew the tablet for faster absorption if the headache is severe.": Crushing or chewing may alter absorption and effectiveness; the tablet should be swallowed whole.

Take home points

• Sumatriptan is for acute migraine relief, not prevention.
• Take it at the first sign of a migraine for best results.
• Avoid combining with serotonergic substances like St. John’s Wort.
• Swallow the tablet whole unless your healthcare provider gives different instructions.

High-flow oxygen therapy via a non-rebreather mask at 12–15 L/min is the first-line treatment for acute cluster headaches. The client should sit upright during administration, and therapy typically continues for about 10–20 minutes or until symptoms resolve.

Rationale for correct answer:
3. "You should use a non-rebreather mask and sit upright during a headache attack.": This ensures high oxygen concentration delivery and optimal breathing mechanics to relieve pain quickly.

Rationale for incorrect answers:

1. "The oxygen should be delivered at a low flow rate of 2 L/min.": This is insufficient for cluster headache relief; high flow is required.

2. "You should use a nasal cannula for delivery of the oxygen.": A nasal cannula cannot deliver the necessary high concentration of oxygen.

4. "Treatment should continue for at least 60 minutes, even if symptoms subside.": Extended therapy is unnecessary and may cause oxygen toxicity; therapy usually lasts 10–20 minutes.

Take home points

• Use 12–15 L/min oxygen via a non-rebreather mask for acute cluster headaches.
• Sit upright during treatment for optimal relief.
• Therapy generally lasts 10–20 minutes, stopping once symptoms resolve.