Dihydroergotamine (DHE) is an older medication approved for the treatment of intractable migraine and cluster headaches. Many of our Neurology colleagues still use this drug and its administration could start while the patient is in the ED.
Intranasal forms have become popular (i.e. Migranal). Intramuscular and subcutaneous administration are also possible.
The typical intravenous dose is 0.25 to 1 mg IV push over 2-3 minutes q 6 hours for 24 to 72 hours.
DHE use is contraindicated in the following patients:
> Patients concurrently on a protease inhibitor or macrolide antibiotic because of increased risk of life- threatening peripheral ischemia (**Black Box Warning**) > Patients with a hypersensitivity to ergot alkaloids > Patients with increased risk of developing vasospastic events > Patients who are concurrently taking vasoconstrictors > Patients who are pregnant or nursing > Patients with hemiplegic or basilar migraines
Monitor for the following potential adverse reactions, which are typically related to vasoconstriction/spasm and warrant immediate abortion of the drug’s administration: