Intravenous dihydroergotamine safe for refractory chronic migraine

1. Intravenous dihydroergotamine (DHE) was found in this retrospective study to be an effective therapeutic option for refractory chronic migraine. 

2. DHE was additionally safe for individuals with elevated risk for cardiovascular events and other cardiovascular risk factors. 

Evidence Rating Level: 2 (Good)

Chronic migraine is a debilitating condition that severely impacts the quality of life for many individuals. For those with cardiovascular risk factors (e.g., ischemic heart disease, prior coronary vasospasm, etc.), managing chronic migraines can be particularly challenging due to limited treatment options. For example, triptans, a first-line abortive treatment for migraines, are contraindicated in these patients. The current study aimed to evaluate the safety, tolerability, and effectiveness of repetitive intravenous dihydroergotamine (DHE), a derivative of ergotamine, as a treatment for refractory chronic migraine specifically in individuals with cardiovascular risk factors. Repetitive DHE infusions have long been used in migraine management, but their use in patients with cardiovascular risks has not been extensively studied until now. The current single-center, retrospective cohort study analyzed 347 refractory chronic migraine patients with either low (< 5.0%) or elevated (≥ 5.0%) 10-year cardiovascular risk scores. The elevated-risk group did have fewer patients receiving maximum doses of DHE (p = .002) and lower median doses of DHE on discharge (p < .001), however with respect to safety and tolerability, the study found that intravenous DHE was generally safe and well-tolerated in patients with cardiovascular risk factors. Adverse events were minimal (although the low-risk group did experience more nausea, 31.3% vs. 14.1%, p = 0.008), and there were no severe cardiovascular complications reported during the treatment course. The effectiveness of DHE infusions was evident in the significant reduction in frequency and intensity of pain associated with migraines (p = .037). The overall findings of the study suggest that DHE for refractory chronic migraines could be safe and effective for those with cardiovascular risk factors. However, further research is needed to confirm these findings in larger, controlled clinical trials.

Click to read the study in Headache

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