Intravenous dihydroergotamine for inpatient management of refractory primary headaches

Objective: To determine dosing and side effects of dihydroergotamine as they affect outcomes in primary headache disorders. Methods: We audited our use of dihydroergotamine for inpatient management of disabling primary headache, focusing on the commonly treated problems. Results: Of patients interviewed, 114 had chronic migraine, 38 had cluster headache, and 11 had new daily persistent headache (NDPH). The mean time to follow-up for the entire cohort was 11 months. The data suggest that IV dihydroergotamine given over 5 days produces improvement in headache and disability in patients with migraine more than shorter courses. It does so with a cumulative effect after discharge up to a month. Giving more dihydroergotamine predicts a greater pain-free rate. Patients with cluster headache benefit from IV dihydroergotamine. In patients with NDPH, only those with migrainous symptoms responded and in that group the response was less robust compared with that seen in the chronic migraine cohort. Conclusions: Intravenous dihydroergotamine is well-tolerated, and longer treatments produce a better outcome. Nausea is the most common adverse effect, and its control is associated with a better outcome. Neurology (R) 2011;77:1827-1832