title: Dihydroergotamine nasal spray for relief of refractory headache: a retrospective chart review.
abstract: OBJECTIVE
  To assess the efficacy and tolerability of dihydroergotamine (DHE) nasal spray for headache treatment in patients refractory to triptans.
  
  
  METHODS
  In this single-center, retrospective study, charts were reviewed to identify patients who received their first prescription for 2.0 mg DHE nasal spray between 2000 and 2004. Patients who failed previous treatments with one or more triptan formulations were considered refractory to triptan treatment and were included in the study. Headache severity was assessed by the patient at the center using a visual analog scale (VAS) of 1 to 10 (10 being most severe) at baseline and 4 weeks after initiating DHE. The responses to DHE were evaluated and categorized as complete response (headache symptoms resolved), partial response (> or = 50% reduction in VAS), or unresponsive (< 50% reduction in VAS). Four weeks after DHE use, any adverse event (AE) that occurred during DHE use was reported by the patient at the center.
  
  
  METHODS
  The efficacy of DHE was determined by headache severity reductions. Tolerability was assessed in terms of AE frequency.
  
  
  RESULTS
  A total of 97 patients met the study criteria; 13 patients were lost to follow-up. Thirty-three patients (34.0%) reported a complete response to DHE treatment, 13 (13.4%) experienced a partial response, and 38 (39.2%) were unresponsive. Seven of 97 patients (7.2%) reported AEs (e.g., nasal congestion, dysphoria) while using DHE.
  
  
  CONCLUSIONS
  This retrospective chart review included patients who failed triptan therapy for treatment of headaches. We found that 47% of patients experienced partial to complete response to DHE treatment. Study limitations included the retrospective design, the small sample size, and the use of patient recollection to evaluate the efficacy and tolerability of DHE. Randomized, double-blind, controlled trials are warranted.
authors.affiliation: Gosy and Associates Pain Treatment and Neurology, LLP, Williamsville, NY 14221, USA. mfisher@gosyassociates.com <mfisher@gosyassociates.com>
authors.forename: Michele
authors.initials: M
authors.lastname: Fisher
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Gosy
authors.forename: Blanka
authors.initials: B
authors.lastname: Heary
authors.forename: Denise
authors.initials: D
authors.lastname: Shaw
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects; D004087:Dihydroergotamine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006261:Headache / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D018712:Analgesics, Non-Narcotic; D004087:Dihydroergotamine