title: Intravenous dihydroergotamine for inpatient management of refractory primary headaches.
abstract: 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.
authors: Department of Neurology, University of California, San Francisco, CA, USA.
authors: Abraham J
authors: AJ
authors: Nagy
authors: Sonia
authors: S
authors: Gandhi
authors: Ria
authors: R
authors: Bhola
authors: Peter J
authors: PJ
authors: Goadsby
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D003027:Cluster Headache / Q000188:drug therapy; D004087:Dihydroergotamine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D019468:Disease Management; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D051270:Headache Disorders, Primary / Q000188:drug therapy*; D006801:Humans; D007275:Injections, Intravenous; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy; D010148:Intractable Pain / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D004087:Dihydroergotamine