Ergotamines for cluster headaches

Examples

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Brand Name	Chemical Name
Migranal	dihydroergotamine mesylate

Brand Name	Chemical Name
Ergotrate Maleate	ergonovine maleate

Brand Name	Chemical Name
Wigraine	ergotamine tartrate with caffeine

Brand Name	Chemical Name
Ergomar	ergotamine tartrate for use under the tongue (sublingual form)

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

How It Works

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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

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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

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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

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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

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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.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Victor M, Ropper AH (2001). Cluster headaches section of Headache and other craniofacial pains. In Adams and Victor's Principles of Neurology, 7th ed., pp. 175–203. New York: McGraw-Hill.

Credits

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Author	Ralph Poore
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Michele Cronen
Associate Editor	Pat Truman
Primary Medical Reviewer	Renée M. Crichlow, MD - Family Medicine
Specialist Medical Reviewer	Seymour Diamond, MD - Neurology
Last Updated	April 21, 2006