title: Exacerbation of headache during dihydroergotamine for chronic migraine does not alter outcome.
abstract: OBJECTIVE
  To evaluate whether headache exacerbation associated with IV dihydroergotamine (DHE) infusion predicts medium-term headache outcome in patients with chronic migraine.
  
  
  METHODS
  This was a retrospective chart review study of the UCSF Headache Center's use of IV DHE for chronic migraine from 2008 to 2012. Medium-term headache outcome was assessed at 6-week follow-up. Univariate and multivariate logistic regression models were used to assess for predictors of outcome.
  
  
  RESULTS
  Patients with chronic migraine (n = 274) were treated with a course of IV DHE. Of 214 with 6-week follow-up, 78% had medium-term headache benefit. In a univariate logistic regression model, headache exacerbation with DHE was associated with lower odds of a positive medium-term headache outcome (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.20-0.91). However, in the multivariate logistic regression model, headache exacerbation was no longer an independent predictor of treatment outcome (OR 0.65, 95% CI 0.28-1.51). Factors that independently predicted outcome were nausea (OR 0.12, 95% CI 0.02-1.00, p = 0.05), age (OR 1.68 for each decade increase in age, 95% CI 1.24-2.28), and medication overuse (OR 0.42, 95% CI 0.18-0.97).
  
  
  CONCLUSIONS
  After controlling for nausea and other factors, headache exacerbation with DHE infusions is not an independent predictor of poor headache outcome and clinicians should not interpret its presence as a reason to stop treatment. The focus of management should be on controlling nausea as it is the most important modifiable factor in achieving a good headache outcome with an inpatient course of IV DHE for chronic migraine.
authors: From the Headache Group, Department of Neurology (M.E., A.A.G., N.Y.R., C.S., P.J.G.), and Epidemiology and Biostatistics (S.S.), University of California, San Francisco; and Headache Group, Basic & Clinical Neuroscience, and NIHR-Wellcome Trust Clinical Research Facility (P.J.G.), King's College London, UK.
authors: Michael
authors: M
authors: Eller
authors: From the Headache Group, Department of Neurology (M.E., A.A.G., N.Y.R., C.S., P.J.G.), and Epidemiology and Biostatistics (S.S.), University of California, San Francisco; and Headache Group, Basic & Clinical Neuroscience, and NIHR-Wellcome Trust Clinical Research Facility (P.J.G.), King's College London, UK.
authors: Amy A
authors: AA
authors: Gelfand
authors: From the Headache Group, Department of Neurology (M.E., A.A.G., N.Y.R., C.S., P.J.G.), and Epidemiology and Biostatistics (S.S.), University of California, San Francisco; and Headache Group, Basic & Clinical Neuroscience, and NIHR-Wellcome Trust Clinical Research Facility (P.J.G.), King's College London, UK.
authors: Nina Y
authors: NY
authors: Riggins
authors: From the Headache Group, Department of Neurology (M.E., A.A.G., N.Y.R., C.S., P.J.G.), and Epidemiology and Biostatistics (S.S.), University of California, San Francisco; and Headache Group, Basic & Clinical Neuroscience, and NIHR-Wellcome Trust Clinical Research Facility (P.J.G.), King's College London, UK.
authors: Stephen
authors: S
authors: Shiboski
authors: From the Headache Group, Department of Neurology (M.E., A.A.G., N.Y.R., C.S., P.J.G.), and Epidemiology and Biostatistics (S.S.), University of California, San Francisco; and Headache Group, Basic & Clinical Neuroscience, and NIHR-Wellcome Trust Clinical Research Facility (P.J.G.), King's College London, UK.
authors: Christoph
authors: C
authors: Schankin
authors: From the Headache Group, Department of Neurology (M.E., A.A.G., N.Y.R., C.S., P.J.G.), and Epidemiology and Biostatistics (S.S.), University of California, San Francisco; and Headache Group, Basic & Clinical Neuroscience, and NIHR-Wellcome Trust Clinical Research Facility (P.J.G.), King's College London, UK. peter.goadsby@kcl.ac.uk.
authors: Peter J
authors: PJ
authors: Goadsby
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D015984:Causality; D002908:Chronic Disease; D015897:Comorbidity; D004087:Dihydroergotamine / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D006261:Headache / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D014662:Vasoconstrictor Agents; D004087:Dihydroergotamine