title: Aprepitant for the management of nausea with inpatient IV dihydroergotamine.
abstract: OBJECTIVE
  To assess the efficacy and tolerability of oral aprepitant, a substance P/neurokinin A receptor antagonist, in controlling nausea associated with IV dihydroergotamine (DHE) administered for medically refractory migrainous headache in patients not responding to standard antiemetics or with a history of uncontrolled nausea with DHE.
  
  
  METHODS
  This was a retrospective chart review of prospectively collected hourly diary data and clinical notes of patients hospitalized between 2011 and 2015 for inpatient treatment with DHE. Patients were classified using the International Classification of Headache Disorders, 3rd edition (beta version). Peak and average daily nausea scores from hourly diaries, or daily entries of notes, and concurrent antiemetic use were collected and tabulated.
  
  
  RESULTS
  Seventy-four patients, of whom 24 had daily diaries, with chronic migraine with or without aura, with or without medication overuse, or new daily persistent headache of a migrainous type, were identified. In 36 of 57 cases in which aprepitant was administered during hospitalization, there was a 50% reduction in the average daily number of as-needed antinausea medications. Of 57 patients, 52 reported that the addition of aprepitant improved nausea. Among 21 of 24 patients with hourly diary data, nausea scores were reduced and in all 12 with vomiting there was cessation of emesis after aprepitant was added. Aprepitant was well tolerated with no treatment emergent adverse events.
  
  
  CONCLUSIONS
  Aprepitant can be effective in the treatment of refractory DHE-induced nausea and emesis. Given the broader issue of troublesome nausea and vomiting in acute presentations of migraine, general neurologists may consider what place aprepitant has in the management of such patients.
  
  
  METHODS
  This study provides Class IV evidence that for patients with medically refractory migraine receiving IV DHE, oral aprepitant reduces nausea.
authors.affiliation: From the Headache Center (D.E.C.), Department of Neurology, Columbia University Medical Center, New York, NY; Headache Group (D.E.C., P.J.G.), Department of Neurology, University of California, San Francisco; and Headache Group (A.R.T., P.J.G.), Basic & Clinical Neuroscience, and NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, UK.
authors.forename: Denise E
authors.initials: DE
authors.lastname: Chou
authors.affiliation: From the Headache Center (D.E.C.), Department of Neurology, Columbia University Medical Center, New York, NY; Headache Group (D.E.C., P.J.G.), Department of Neurology, University of California, San Francisco; and Headache Group (A.R.T., P.J.G.), Basic & Clinical Neuroscience, and NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, UK.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Tso
authors.affiliation: From the Headache Center (D.E.C.), Department of Neurology, Columbia University Medical Center, New York, NY; Headache Group (D.E.C., P.J.G.), Department of Neurology, University of California, San Francisco; and Headache Group (A.R.T., P.J.G.), Basic & Clinical Neuroscience, and NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, UK. peter.goadsby@kcl.ac.uk.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Goadsby
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects*; D000932:Antiemetics / Q000627:therapeutic use*; D000077608:Aprepitant; D004087:Dihydroergotamine / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007297:Inpatients; D008881:Migraine Disorders / Q000188:drug therapy; D009025:Morpholines / Q000627:therapeutic use*; D009325:Nausea / Q000188:drug therapy* / Q000209:etiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000932:Antiemetics; D009025:Morpholines; D000077608:Aprepitant; D004087:Dihydroergotamine