II. Indications
-
Migraine Abortive Management
- Rarely used in modern U.S. Migraine Management (largely replaced by Triptans)
III. Contraindications
- Children
- Hemiplegic Migraine (or basilar Migraine)
- Ischemic or vasospastic cardiac disease
- Sepsis
- Peripheral Vascular Disease
- Vascular surgery
- Renal Impairment
- Hepatic Impairment
- Uncontrolled Hypertension
IV. Mechanism
- Ergot derivative acting at alpha adrenergic, serotonergic and Dopaminergic Receptors
- Binds and stimulates 5-HT1D receptor, a Serotonin receptor subtype
- Constricting Cerebral Vessels
- Also acts at trigeminal Sensory Nerve Endings to suppress release of pro-inflammatory neuropeptides
V. Precautions
- Give first dose in health care facility in those with Cardiovascular Risk Factors
-
Ergotamines have been replaced by Triptans for multiple reasons
- Low oral Bioavailability
- High risk for Medication Overuse Headache
- Common associated Nausea and Vomiting
- Serious adverse Drug Interaction risk
VI. Medications
- See Intranasal Dihydroergotamine (Migranal)
- Dihydroergotamine (DHE-45) 1 mg/ml
- Brekiya Auto-Injector 1 mg/ml injection
- Inject into mid-thigh
VII. Dosing: Adults
- See Intranasal Dihydroergotamine (Migranal)
- Parenteral Dihydroergotamine
- Initial: 1 mg SC/IM/IV over 3-4 minutes
- Repeat: May repeat every 1 hour (up to 2 mg IV or 3 mg IM/SC in 24 hours)
- Maximum: 6 mg/week, 20 mg/month
VIII. Adverse Effects
- Cerebrovascular Accident
- Retroperitoneal fibrosis
IX. Safety
- Avoid in Pregnancy (Pregnancy Category X)
- Avoid in Lactation
X. Drug Interactions
- Avoid with concurrent similar agents
XI. Efficacy
- Advantages
- Weaker Vasoconstrictor (less Side Effects)
- No Rebound Headache
XII. Resources
- Dihydroergotamine Mesylate Injection (DailyMed)