Dihydroergotamine: Migraine Relief, Uses, & Dosage Guide

Summary of Key Points

Dihydroergotamine is a medication commonly prescribed to manage various types of headaches, including migraines and cluster headaches. It works by constricting blood vessels in the brain, which helps alleviate headache symptoms. This medication is available in different forms, such as a nasal spray and an injection, and should only be used under the guidance of your healthcare provider. Adhering to the prescribed dosing instructions is crucial to ensure both safety and effectiveness.

Names of the Medication

US Brand Name: Migranal (Dihydroergotamine)

The generic name refers to the active ingredient in a medication, while the brand name is the name given by the manufacturer. In this article, the generic name is included in parentheses to provide clarity.

Pharmacologic Category

Dihydroergotamine is classified as an Ergot Alkaloid, a group of medications used to treat certain types of headaches.

Dosing Guidelines for Dihydroergotamine

Dihydroergotamine is prescribed to treat a variety of headache disorders in adults. The appropriate dosage depends on the specific condition being addressed. Always consult your healthcare provider before making any changes to your prescribed dose. For personalized advice, you may also consider scheduling a telemedicine appointment with one of our providers.

Dosing for Migraine

Dose: 1 mg via nasal spray or injection, repeated every hour as needed, up to a maximum of 3 mg per day. Do not exceed 6 mg per week.

Dosing for Cluster Headache

Dose: 1 mg via nasal spray or injection, repeated every hour as needed, up to a maximum of 3 mg per day. Do not exceed 6 mg per week.

Dosing for Tension-Type Headache

Dose: 1 mg via nasal spray or injection, repeated every hour as needed, up to a maximum of 3 mg per day. Do not exceed 6 mg per week.

Dosing for Chronic Migraine

Dose: 1 mg via nasal spray or injection, repeated every hour as needed, up to a maximum of 3 mg per day. Do not exceed 6 mg per week.

Dosing for Hemicrania Continua

Dose: 1 mg via nasal spray or injection, repeated every hour as needed, up to a maximum of 3 mg per day. Do not exceed 6 mg per week.

Dosing for Post-Dural Puncture Headache

Dose: 1 mg via nasal spray or injection, repeated every hour as needed, up to a maximum of 3 mg per day. Do not exceed 6 mg per week.

Dosing for Medication Overuse Headache

Dose: 1 mg via nasal spray or injection, repeated every hour as needed, up to a maximum of 3 mg per day. Do not exceed 6 mg per week.

Dosing for Acute Migraine Attack

Dose: 1 mg via nasal spray or injection, repeated every hour as needed, up to a maximum of 3 mg per day. Do not exceed 6 mg per week.

Dosing for Vascular Headache

Dose: 1 mg via nasal spray or injection, repeated every hour as needed, up to a maximum of 3 mg per day. Do not exceed 6 mg per week.

Dosing for Refractory Headache

Dose: 1 mg via nasal spray or injection, repeated every hour as needed, up to a maximum of 3 mg per day. Do not exceed 6 mg per week.

Dosage Forms and Strengths

1. Nasal Spray: 4 mg/mL
2. Injection: 1 mg/mL

Administration Instructions

Dihydroergotamine must be used exactly as directed by your healthcare provider. For the nasal spray, ensure you prime the spray pump before the first use and administer the medication into each nostril as instructed. For the injection, it is typically administered either subcutaneously (under the skin) or intramuscularly (into the muscle). Always follow the specific instructions provided with your prescription. If you have any questions or concerns, reach out to your healthcare provider or schedule a telemedicine visit for additional guidance.

Adverse Reactions and Side Effects

As with any medication, dihydroergotamine can cause side effects. While some are relatively common and mild, others are rare but potentially serious. If you notice any side effects, it’s important to contact your healthcare provider promptly for guidance.

Common Side Effects (1-10%): These include nausea, vomiting, dizziness, and nasal irritation, particularly when using the dihydroergotamine nasal spray.

Less Common Side Effects (0.1-1%): Fatigue, muscle pain, diarrhea, and dry mouth may occur in a smaller percentage of patients.

Rare Side Effects (<0.1%): Although uncommon, serious side effects such as cardiovascular events (e.g., heart attack or stroke), chest pain, difficulty breathing, and severe allergic reactions have been reported.

Contraindications

Contraindications refer to specific conditions or circumstances where a medication should not be used because it may cause harm. For dihydroergotamine, certain medical conditions make its use unsafe. Below is a list of these contraindications, along with explanations of the associated risks:

Uncontrolled Hypertension (High Blood Pressure):Dihydroergotamine can constrict blood vessels, which may worsen high blood pressure and significantly increase the risk of severe cardiovascular complications, such as stroke or heart attack.

Coronary Artery Disease: This condition affects the blood vessels that supply the heart. Because dihydroergotamine can narrow these vessels, it may trigger chest pain (angina) or, in severe cases, a heart attack.

Peripheral Vascular Disease: In individuals with this condition, dihydroergotamine can further reduce blood flow to the extremities, potentially causing pain, numbness, or even tissue damage.

Severe Liver or Kidney Disease: The liver and kidneys play a critical role in processing and eliminating medications. Impaired function in these organs can lead to the accumulation of dihydroergotamine in the body, increasing the likelihood of harmful side effects.

Pregnancy:Dihydroergotamine is not safe during pregnancy because it can stimulate uterine contractions, which may result in miscarriage or premature labor.

Use of Strong CYP3A4 Inhibitors: Certain medications, such as antifungals (e.g., ketoconazole) or antibiotics (e.g., clarithromycin), can interfere with the metabolism of dihydroergotamine, leading to dangerously high levels of the drug in the body.

Drug-to-Drug Interactions

Dihydroergotamine can interact with other medications, potentially causing harmful side effects or reducing the effectiveness of treatment. Below are some common drugs that may interact with dihydroergotamine:

1. Macrolide Antibiotics: Medications such as erythromycin (Ery-Tab) and clarithromycin (Biaxin) can increase dihydroergotamine levels, heightening the risk of toxicity.
2. Antifungal Medications: Drugs like ketoconazole (Nizoral) and itraconazole (Sporanox) inhibit the enzyme responsible for breaking down dihydroergotamine, which may lead to serious side effects.
3. Protease Inhibitors: HIV treatments, including ritonavir (Norvir) and indinavir (Crixivan), can elevate dihydroergotamine levels, increasing the likelihood of dangerous side effects.
4. Triptans: Combining dihydroergotamine with medications like sumatriptan (Imitrex) or rizatriptan (Maxalt) can amplify the risk of excessive blood vessel constriction, potentially leading to heart problems or stroke.
5. SSRIs and SNRIs: Antidepressants such as fluoxetine (Prozac) and venlafaxine (Effexor) may increase the risk of serotonin syndrome when used alongside dihydroergotamine.

Dihydroergotamine in Pregnancy

Is it safe to take dihydroergotamine during pregnancy?

No, dihydroergotamine is not considered safe for use during pregnancy. This medication can cause uterine contractions, which may lead to miscarriage, premature labor, or other complications. If you are pregnant or planning to become pregnant, it’s essential to discuss alternative treatment options with your healthcare provider. You can also schedule a telemedicine appointment with one of our specialists to explore a personalized treatment plan.

Dihydroergotamine While Breastfeeding

Is it safe to take Dihydroergotamine while breastfeeding?

Dihydroergotamine is generally not recommended for breastfeeding mothers. This medication, an ergotamine derivative, can pass into breast milk and may cause harmful effects in nursing infants, such as vomiting, diarrhea, or reduced blood flow to vital organs. If you are breastfeeding, it is essential to consult your healthcare provider to explore safer alternatives. You may also consider scheduling a telemedicine visit with one of our providers to discuss your options in detail.

Estimated Cost of Dihydroergotamine

The cost of a 30-day supply of Dihydroergotamine without insurance can vary depending on the pharmacy and your location. With a GoodRX coupon, the price typically ranges between $50 and $100. However, prices may differ, so it’s a good idea to check with your local pharmacy or use a coupon service like GoodRX to find the most affordable option.

Possible Alternatives to Dihydroergotamine

If Dihydroergotamine is not suitable for you, there are several alternative treatments available for the conditions it is commonly prescribed to address. Below are some options to consider. Always consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss these alternatives in greater detail.

Migraine

Triptans (e.g., sumatriptan), nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, and lifestyle modifications such as stress management and dietary adjustments can help reduce the frequency and severity of migraines.

Cluster Headache

Oxygen therapy, triptans (e.g., sumatriptan), and preventive medications such as verapamil are effective options for managing cluster headaches.

Tension-Type Headache

Over-the-counter pain relievers like acetaminophen or ibuprofen, combined with relaxation techniques, may help alleviate symptoms of tension-type headaches.

Chronic Migraine

Botox injections, CGRP inhibitors (e.g., erenumab), and lifestyle changes, including regular exercise and maintaining proper sleep hygiene, can be beneficial for managing chronic migraines.

Hemicrania Continua

Indomethacin is typically the first-line treatment for this condition and is often highly effective.

Post-Dural Puncture Headache

Caffeine, bed rest, and an epidural blood patch are commonly recommended remedies for relieving symptoms of post-dural puncture headaches.

Medication Overuse Headache

Gradual withdrawal of the overused medication, combined with preventive treatments such as CGRP inhibitors or tricyclic antidepressants, is often the preferred approach for managing medication overuse headaches.

Acute Migraine Attack

Triptans (e.g., rizatriptan), NSAIDs, and anti-nausea medications can provide effective relief during acute migraine attacks.

Vascular Headache

Preventive treatments such as beta-blockers (e.g., propranolol) or calcium channel blockers (e.g., verapamil) may help reduce the occurrence of vascular headaches.

Refractory Headache

For headaches that do not respond to standard treatments, a combination of medications such as anticonvulsants (e.g., topiramate) or antidepressants (e.g., amitriptyline) may be considered.

Recent Updates on Dihydroergotamine Research

Recent research has focused on developing new formulations of Dihydroergotamine to improve its effectiveness and reduce side effects. One promising advancement is intranasal Dihydroergotamine, which allows for faster absorption and may provide quicker relief for acute migraine attacks. Researchers are also investigating the potential benefits of combining Dihydroergotamine with other medications, such as CGRP inhibitors, to enhance its efficacy in treating refractory headaches.

Ongoing clinical trials are evaluating the long-term safety of Dihydroergotamine, particularly for patients with chronic migraines and other headache disorders. These studies aim to provide a clearer understanding of the risks and benefits associated with prolonged use.

If you are interested in learning about new treatment options or participating in clinical trials, consult your healthcare provider. You can also schedule a telemedicine consultation with one of our specialists to discuss the latest research and how it may apply to your treatment plan.

James Kingsley

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