Intravenous dihydroergotamine for inpatient management of refractory primary headaches

Abraham J. Nagy, Sonia Gandhi, Ria Bhola, Peter J. Goadsby*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

106 Citations (Scopus)

Abstract

Objective: To determine dosing and side effects of dihydroergotamine as they affect outcomes in primary headache disorders.

Methods: We audited our use of dihydroergotamine for inpatient management of disabling primary headache, focusing on the commonly treated problems.

Results: Of patients interviewed, 114 had chronic migraine, 38 had cluster headache, and 11 had new daily persistent headache (NDPH). The mean time to follow-up for the entire cohort was 11 months. The data suggest that IV dihydroergotamine given over 5 days produces improvement in headache and disability in patients with migraine more than shorter courses. It does so with a cumulative effect after discharge up to a month. Giving more dihydroergotamine predicts a greater pain-free rate. Patients with cluster headache benefit from IV dihydroergotamine. In patients with NDPH, only those with migrainous symptoms responded and in that group the response was less robust compared with that seen in the chronic migraine cohort.

Conclusions: Intravenous dihydroergotamine is well-tolerated, and longer treatments produce a better outcome. Nausea is the most common adverse effect, and its control is associated with a better outcome.

Original languageEnglish
Pages (from-to)1827-1832
Number of pages6
JournalLancet neurology
Volume77
Issue number20
DOIs
Publication statusPublished - 15 Nov 2011

Keywords

  • ACUTE MIGRAINE
  • H-3 DIHYDROERGOTAMINE
  • BINDING-SITES
  • DOUBLE-BLIND
  • THERAPY
  • ATTACKS
  • DHE
  • PHARMACOKINETICS
  • DEXAMETHASONE
  • ANTAGONIST

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