Ergotamines for cluster headaches

Examples

Generic Name	Brand Name
dihydroergotamine mesylate (D.H.E.)	Migranal
ergonovine maleate
ergotamine tartrate with caffeine	Cafergot

D.H.E., which is generally given as a shot, is also available as a nasal spray.

How It Works

Ergotamine narrows blood vessels in the head (vasoconstriction), which relieves pain by reducing pressure on pain-sensitive structures in the head and scalp, which may be associated with cluster headaches. It may also affect certain brain chemicals that affect how a person feels pain.

Why It Is Used

Ergotamine may be used to prevent or treat cluster headaches.

A combination medication containing ergotamine, phenobarbital, and belladonna alkaloids (Bellergal-S) may sometimes be used to prevent cluster headaches.

D.H.E. given through a vein (intravenous, or IV) or by an injection in the muscle (intramuscular, or IM) may be used for emergency treatment of a severe cluster headache. D.H.E. is also available as a nasal spray (Migranal).

How Well It Works

When taken at bedtime or several hours before going to sleep, ergotamine is especially useful for preventing headaches that occur at night.¹

D.H.E., which is generally given as a shot, may provide rapid relief of a headache. A person may be able to give his or her own shot.

Side Effects

Side effects are more common with high doses and may include:

• Nausea and vomiting.
• Cold, clammy hands and feet (due to narrowing of blood vessels).
• Muscle pain.
• Dizziness, numbness, vague feeling of discomfort or anxiety.
• Bitter or foul taste in the mouth or throat (nasal spray only).
• Irritation or inflammation in the nose (nasal spray only).

Ergotamine may be combined with caffeine or other medications to help control nausea and vomiting, which are common side effects of the medication.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

To treat a cluster headache that has already begun, ergotamine must be used as early as possible for best results. The sooner you treat the headache, the less painful it may be.

If you are taking ergotamine, it is very important to follow your doctor's recommendations on when and how often to take it. Overuse of ergotamine can lead to a rebound headache.

Ergotamine may be used with other medications taken to control cluster headaches, such as methysergide, verapamil, or lithium. It should not be used with serotonin receptor agonists (triptans), such as sumatriptan, zolmitriptan, naratriptan, or rizatriptan.

Ergotamine should not be used to treat headaches in children. In addition, it should not be used in women who are pregnant or who are thinking about becoming pregnant.

Ergotamine should not be used by pregnant women or people who have:

• A fever.
• Uncontrolled high blood pressure (hypertension).
• Cerebrovascular, cardiovascular, or peripheral arterial diseases.
• Coronary or ischemic heart disease.
• Liver (hepatic) or kidney (renal) diseases.
• Enlarged prostate.
• Bowel obstruction.
• Recent surgery.
• Glaucoma.
• A history of irregular heartbeat (arrhythmia).
• Problems with circulation.

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Author:	Douglas Dana Ralph Poore	Last Updated: August 14, 2006
Medical Review:	Renée M. Crichlow, MD - Family Medicine Adam Husney, MD - Family Medicine Colin Chalk, MD, CM, FRCPC - Neurology Seymour Diamond, MD - Neurology
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