Updated Evaluation of IV Dihydroergotamine (DHE) for Refractory Migraine: Patient Selection and Special Considerations

Updated Evaluation of IV Dihydroergotamine (DHE) for Refractory Migraine: Patient Selection and Special Considerations

Dihydroergotamine (DHE) is an ergot alkaloid derivative of substances produced by rye fungus. Ergotamine was first used in the field of gynecology and obstetrics, then used for migraine treatment a few years later. DHE was developed as a derivative of ergotamine. DHE, when compared to ergotamine, de...

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Bibliographic Details
Published in:Journal of pain research Vol. 13; pp. 859 - 864
Main Authors: Shafqat, Rafia, Flores-Montanez, Yadira, Delbono, Victoria, Nahas, Stephanie J
Format: Journal Article
Language:English
Published: New Zealand Dove Medical Press Limited 01-01-2020
Taylor & Francis Ltd
Dove
Dove Medical Press
Subjects:
Abortion
Alkaloids
Analysis
Bioavailability
Blood flow
Cardiac patients
cardiovascular risk factors
Dairy products industry
Dihydroergotamine
Drug dosages
Emergency medicine
Ergot alkaloids
Ergotamine
Fungi
Gastrointestinal agents
Headaches
Infants
infusion
inpatient
lactating
LSD
Lysergic acid diethylamide
Menstruation
Metabolism
Metabolites
Migraine
Milk
Milk production
Miscarriage
Obstetrics
pediatric
pregnant
Pregnant women
Review
rye fungus
Vasoconstriction
United States > US
lactating
infusion
rye fungus
inpatient
ergotamine
cardiovascular risk factors
pediatric
pregnant
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Description
Summary:Dihydroergotamine (DHE) is an ergot alkaloid derivative of substances produced by rye fungus. Ergotamine was first used in the field of gynecology and obstetrics, then used for migraine treatment a few years later. DHE was developed as a derivative of ergotamine. DHE, when compared to ergotamine, demonstrates greater alpha-adrenergic antagonist activity, lower arterial vasoconstriction, less dopaminergic agonism, and lower emetic potential. DHE can be delivered via several routes including intravenous (IV), intramuscular (IM), subcutaneous (SC), intranasal (IN), oral, and orally inhaled (although the latter two are not available in the USA and the last remains experimental only). DHE can be used in an outpatient basis in infusion centers, emergency departments, and urgent care centers, as well as inpatient treatment for admitted patients. There are protocols for adults as well as pediatric migraine treatment. DHE and other ergot alkaloids are considered contraindicated in pregnant women as they decrease uterine blood flow and increase uterine muscle contractility predisposing to spontaneous abortion. DHE during lactation is also not recommended as it can lead to gastrointestinal distress and weakness in infants; it can also suppress milk production. Caution should be taken before administering DHE in patients with cardiovascular risk factors. DHE is an older drug with an interesting history, yet it is still clinically useful today for patients with migraine attacks not responsive to triptans, who have a greater burden from migraine, and in refractory migraine.
Bibliography:ObjectType-Article-2
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ISSN:1178-7090
1178-7090
DOI:10.2147/JPR.S203650