Dihydroergotamine

Subcutaneous and intramuscular injections are generally more effective than the nasal spray and can be self-administered by patients.^[11] Intravenous injection is considered very effective for severe migraine or status migrainosus. Dihydroergotamine is also used in the treatment of medication overuse headache.^[12]

Dihydroergotamine is indicated for the acute treatment of migraine.^[6][7]

Dihydroergotamine is contraindicated with potent CYP3A4 inhibitors, like macrolide antibiotics.^[13]

Contraindications for dihydroergotamine include: pregnancy, kidney failure or liver failure, coronary, cerebral, and peripheral vascular disease, hypersensitivity reactions, sepsis, and uncontrolled hypertension.^[13]

Nausea is a common side effect of intravenous administration and less common in other modes.^[14] Antiemetics can be given prior to DHE to counteract the nausea. Risks and contraindications are similar to the triptans. DHE and triptans should never be taken within 24 hours of each other due to the potential for coronary artery vasospasm.^[15] DHE produces no dependence.^[16]

Dihydroergotamine was synthesized by Albert Hofmann and Werner Stoll at Sandoz in 1943.^[8] It was first described in the scientific literature that same year.^{[8][23][24][25][26]} Dihydroergotamine was first approved for medical use under the brand name D.H.E. 45 in 1946.^[8][9] Dihydroergotamine is derived from ergot, a fungus that grows on rye and other grains.^[27][28]