Ergotamine and dihydroergotamine: a review.
The ergot alkaloids were the first specific antimigraine therapy available. However, with the advent of the triptans, their use in the treatment of migraine has declined and their role has become less clear. This review discusses the pharmacology, efficacy, and safety of the ergots. In randomized clinical trials, oral ergotamine was found to be superior to placebo, but inferior to 100 mg of oral sumatriptan. In contrast, rectal ergotamine was found to have higher efficacy (73% headache relief) than rectal sumatriptan (63% headache relief). Intranasal dihydroergotamine was found to be superior to placebo, but less effective than subcutaneous and intranasal sumatriptan. Ergotamine is still widely used in some countries for the treatment of severe migraine attacks. It is generally regarded as a safe and useful drug if prescribed for infrequent use, in the correct dose, and in the absence of contraindications; however, safer and more effective options do exist in the triptans. In patients with status migrainous and patients with frequent headache recurrence, ergotamine is still probably useful.
Bigal
Marcelo E
ME
The New England Center for Headache, 778 Long Ridge Road, Stamford, CT 06902, USA. mbigal@aecom.yu.edu
Tepper
Stewart J
SJ
D004087:Dihydroergotamine / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004878:Ergotamine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D018170:Sumatriptan / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
D004087:Dihydroergotamine; D018170:Sumatriptan; D004878:Ergotamine