Dihydroergotamine: role in the treatment of migraine

BACKGROUND: Dihydroergotamine belongs to the oldest migraine-specific drugs. Mainly used by headache experts today, its properties are unfamiliar to many physicians. OBJECTIVE: To evaluate the modes of administration, effectiveness and safety profile of dihydroergotamine in the treatment of migraine. METHODS: Searching Medline and available reviews on the topic. RESULTS/CONCLUSION: Evidence-based data are scarce. Parenteral dihydroergotamine seems to be as effective as or less effective than triptans with regard to pain control, but more effective than other drugs used in the treatment of attacks. The nasal spray is more effective than placebo, but less effective than triptans. Additional reports suggest that dihydroergotamine is particularly useful in migraineurs not satisfactorily responding to analgesics, in those with long attacks or headache recurrence, and those at risk of medication-overuse headache. Effectiveness of the oral formulation in migraine prevention is not substantiated by clinical trials. The adverse effect profile is very favorable compared to other ergot alkaloids.