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Dihydroergotamine (DHE)
     

A New Formulation of Dihydroergotamine (DHE) is Effective for Sustaining Relief in the Acute Treatment of Migraine (July 2003)

Repetitive intravenous administration of valproate sodium in intractable migraine: comparison with intravenous dihydroergotamine (DHE) (Posted Nov 2000)

A Retrospective Study of Self-Administered Subcutaneous Dihydroergotamine in the Outpatient Treatment of Chronic Daily Headache Associated with Medication Overuse (Posted June 2000)

DHE: An Old Drug Made New (Posted Jan 1999)

A Retrospective Study of Self-Administered Subcutaneous Dihydroergotamine in the Outpatient Treatment of Chronic Daily Headache Associated with Medication Overuse

Objective:
To determine the efficacy and tolerability of self-administered subcutaneous (SQ) dihydroergotamine (DHE) in the treatment of chronic daily headache (CDH) associated with medication overuse.

Background:
An outpatient protocol has been used at the Mayo Clinic for several years utilizing self-administered SQ DHE in the treatment of CDH with medication overuse. An attempt to reduce the frequency of symptomatic medication use is made while DHE is administered for 2-4 weeks. Efficacy and tolerability of SQ DHE in this group of patients have not been previously reviewed.

Methods:
The records of 70 patients started on a SQ DHE regimen for CDH were reviewed to confirm the diagnosis. These patients underwent a phone interview. The pre- and post-treatment frequency of symptomatic medication use was verified. Patients were questioned about change in quality of life and overall satisfaction. Data was analyzed on an intent-to-treat basis.

Results:
All 70 patients had CDH. Patients were treated with SQ DHE for 2-4 weeks. Daily doses varied from 0.5 mg. qd to 1 mg. bid. 47/70 patients were reached for phone interviews. 5/47 patients did not complete the regimen citing side effects that included nausea and chest tightness. 2 of these 5 patients gave post-treatment information and were included in the analysis. 41 of the 44 patients analyzed were overusing symptomatic medications (greater than 2 days per week). Prior to treatment, 93% of patients were using symptomatic medications daily or qod, whereas only 50% of patients were using symptomatic medications daily or qod after the DHE treatment. Quality of life was improved in 57% of patients, and 68% of patients were satisfied with the protocol and its results.

Conclusions:
Outpatient SQ DHE is efficacious and well tolerated in the treatment of CDH associated with medication overuse. A 2-4 week treatment protocol allows many patients to decrease the frequency of symptomatic medication use.


DHE: An Old Drug Made New
The following is the abstract taken from: Oliver RL. DHE: An old drug made new. Amer J Pain Mgmt 1999; 9:35-38.

Dihydroergotamine (DHE) has been available for over 50 years for the abortion of migraine and prior to that, there was ergotamine tartrate, a similar medicine but one with more adverse effects. In recent years, additional methods of administration have made DHE more usable. Each form (intravenous, intramuscular, subcutaneous, and intranasal) has advantages and disadvantages. Intravenous administration is considered to be the best way to treat chronic daily headache and status post migranosus, inpatient or outpatient. Intramuscular and subcutaneous administration of DHE are the best ways to get quick headache relief without requiring the patient to be hospitalized, in most cases.

Intranasal (nasal spray) is the most patient-friendly route of administration and is often as efficacious as the other forms of DHE, while still being as effective and safe for abortion of migraine as new medications currently being marketed. Whatever the administration form, dihydroergotamine has proven to still be an effective agent for the abortion of migraine.