Sumatriptan induced Hypertension: A case report

Dharani devi

Emergency Physician, Kauvery Hospital, Vadapalani, Chennai, Tamil Nadu

Abstract

Background

Sumatriptan is a medication usually prescribed for acute migraine and cluster headaches. Sumatriptan induced hypertension occurs primarily due to its vasoconstrictive effects (binding to 5-HT1B/1D receptors in blood vessels) which can lead to increased blood pressure in susceptible individuals. Although this drug induced hypertension is rare and is often misdiagnosed or a missed diagnosis, it is crucial to recognize, investigate and avoid drugs that cause hypertension, and thus prevent further complications.

Case Presentation

In this report, we detail the case of 40-yearsaged female with history of migraine, for which she was prescribed sumatriptan. She presented to emergency department with chief complaints of headache for past 2 days. No history of giddiness, vomiting, limb weakness or numbness, fever, tinnitus, facial pain, neck pain.

On Examination

On examination patient was conscious, oriented and obeying to oral commands.

Vitals: BP – 210/120 mmHG, HR – 88/min.

Systemic examination was normal.

Given these findings and clinical evaluation, supportive care was promptly initiated with oral antihypertensive and sumatriptan, identified as the potential trigger, was discontinued.

Notably, patient had no history of any other known comorbidities or smoking/alcohol history.

The absence of other risk factors increased the likelihood that sumatriptan was responsible for her condition.

Discussion

This report highlights the importance of careful monitoring of symptoms and vitals signs in patients being treated with sumatriptan.

For such patients newly introduced acute treatments like calcitonin gene-related peptide (CGRP) receptor antagonists (ubrogepant, rimegepant); a serotonin (5-HT1F) agonist (lasmiditan); a nonsteroidal anti-inflammatory drug (celecoxib oral solution); and a neuromodulatory device can be used.

Identifying such unusual cases like drug induced hypertension help to highlight the potential risk of complications like intracranial hemorrhage, myocardial infarction etc.

In rare instances it might cause reversible changes in cerebral blood vessels known as reversible cerebral vasoconstriction syndrome and peripheral Vasoconstriction.

Hence sumatriptan should be avoided in elderly patients, known Chronic kidney disease, cardiovascular disease.

Conclusion

This case report highlights a rare condition drug induced hypertension following the use of sumatriptan. Thus timely recognition and management of such disease will improve the outcome and prevent further complications. This case emphasizes the importance of considering drug induced disease in differential diagnosis of patient presenting with headache and high blood pressure, who are on sumatriptan. Thus such studies will help the treating physicians to think of alternative medications for acute migraine and cluster headaches. Further research is needed to better understand the mechanism of drug induced hypertension and to advance more effective prevention and treatment plan.

References

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