Intravenous Dihydroergotamine for Inpatient Headache Management

In the inpatient management of disabling primary headache at one center, repetitive IV DHE was well tolerated and effective, particularly with longer treatment duration.

In the inpatient treatment of refractory headache, serial intravenous dihydroergotamine (IV DHE) dosing is a mainstay. In this study, the authors assessed their own use of IV DHE in 114 patients with chronic migraine, 38 with cluster headache, and 11 with new daily persistent headache. Following pretreatment with an antiemetic (ondansetron), IV DHE in normal saline was infused for 1 hour, every 8 hours, for a total of 12 doses over 5 days. The patients were followed for a mean of 11 months.

The DHE protocol improved headache and reduced disability more than shorter courses have in previous studies. The cumulative effect lasted up to 1 month. Higher total dose of DHE predicted a greater pain-free rate. Nausea was the most common adverse effec…

Reviewing Author

Stephen D. Silberstein, MD