Headache worsening after treatment with IV dihydroergotamine (DHE) does not predict poor headache outcome in the medium term among patients with chronic migraine, according to research published March 1 in Neurology. According to r
esearchers, headache exacerbation is not a sufficient reason to stop treatment. According to researchers, physicians should focus on controlling nausea, which is the most important modifiable factor in achieving a good headache outcome.
IV DHE has been used to treat patients with migraine for decades. After receiving this therapy, some patients have transient headache worsening, and this may be interpreted as a reason to stop the treatments. Michael Eller, MD, Assistant Clinical Professor of Neurology at the University of California, San Francisco and colleagues performed a retrospective chart review to determine whether transient headache worsening after IV DHE infusion predicts medium-term headache outcomes in patients with chronic migraine.
Nausea was the modifiable risk factor with the greatest effect on headache outcome. In an adjusted model, nausea was significantly associated with headache exacerbation with DHE infusion. Nausea also was an independent predictor of decreased likelihood of medium-term headache benefit in the fully adjusted model, as was medication overuse. Older age was strongly associated with increased odds of headache benefit.
“Clinicians in all settings should focus their efforts on aggressive nausea control during a course of IV DHE for chronic migraine.” Younger patients with chronic migraine were less likely to benefit from an inpatient course of IV DHE, and this finding “highlights an even greater need for nausea control in that population.”
www.neurology reviews.com
May, 2016