An ergot medicine for acute migraine and cluster headache
Dihydroergotamine
An ergot medicine used to treat acute attacks of migraine and cluster headache.
What is Dihydroergotamine?
Dihydroergotamine is an ergot medicine used to treat acute attacks of migraine and cluster headache. Its dominant risk is that it narrows blood vessels throughout the body, which can be dangerous, so it must not be combined with triptans or with strong medicines that raise its levels (CYP3A inhibitors), and it is avoided in people with heart or circulation problems. It must not be used in pregnancy. It is taken to treat an attack rather than to prevent headaches, and it is used under medical guidance because of these important restrictions.
Education and reference only. This is a plain-language guide to Dihydroergotamine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Dihydroergotamine is one of the ergot medicines, an older group used for severe headaches. It is used to treat an acute attack of migraine, and also cluster headache, helping to bring an attack under control once it has started. It works by acting on blood vessels and on chemical signals involved in headache. Because it narrows blood vessels, it carries important risks and is used with strict precautions. It is given by injection or as a nasal spray, depending on what is available, and is used under medical guidance.
How it works
During a migraine, blood vessels around the brain widen and inflammatory signals are released, contributing to the pain. Dihydroergotamine acts on serotonin receptors and on blood vessels to tighten them and to dampen those headache signals, which helps end an attack. The downside is that this vessel-narrowing effect is not limited to the head: it can tighten blood vessels elsewhere in the body too, including those supplying the heart and limbs, which is why it can be dangerous in people with heart or circulation problems and why it must not be stacked with other vessel-narrowing headache medicines.
Company & origin
Originated / developed by: Specialist manufacturers.
An older ergot-type medicine used in the UK to treat acute attacks of migraine and cluster headache.
What it treats
Conditions Dihydroergotamine is used for
Practical use
How to take Dihydroergotamine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Use it to treat an attack, by injection or nasal spray as your prescriber directs, rather than to prevent headaches.
- Do not use it within at least a day of taking a triptan, as combining vessel-narrowing medicines is dangerous.
- Tell your prescriber about all your medicines, especially certain antibiotics, antifungals or HIV medicines that can raise its levels.
- Do not use it if you are or might be pregnant, and discuss reliable contraception with your prescriber.
- Report chest pain, cold or numb fingers or toes, or severe leg pain straight away, as these can mean too much vessel narrowing.
Weighing it up
Advantages & disadvantages of Dihydroergotamine
Advantages
- Can be effective for ending an acute migraine or cluster headache attack.
- Offers an option when other acute treatments have not worked.
- Available as an injection or nasal spray for use during an attack.
Disadvantages
- Narrows blood vessels throughout the body, which can be dangerous.
- Must not be combined with triptans or strong medicines that raise its levels, and is unsafe in heart or circulation disease.
- Must not be used in pregnancy, and overuse can cause more headaches.
Practical use
Good to know
The dominant theme with dihydroergotamine is blood-vessel narrowing and the dangers that brings. It must not be used together with triptans, another group of migraine medicines that also narrow vessels, and it must not be combined with strong medicines that raise its levels in the body (known as CYP3A inhibitors, which include some antibiotics and antifungals and certain HIV medicines), because this can cause severe, prolonged vessel narrowing. It is avoided in people with heart disease, poor circulation, uncontrolled high blood pressure or a history of stroke, and it must not be used in pregnancy. It is for treating an attack, not for preventing headaches, and overusing it can itself cause more headaches. Tell your prescriber all your medicines and any heart or circulation problems before using it.
Who should not take it / use with caution
- People with heart disease, poor circulation, uncontrolled high blood pressure or a history of stroke or mini-stroke must not use it.
- It must not be used in pregnancy, and is avoided while breastfeeding.
- It must not be combined with triptans or with strong medicines that raise its levels (CYP3A inhibitors).
Monitoring
- Reviewing how often attacks happen and how often the medicine is used, to avoid overuse.
- Watching for signs of too much vessel narrowing, such as cold or numb hands and feet or chest pain.
- Checking heart and circulation risk before and during use.
Side effects
- Nausea and vomiting.
- Tingling, numbness or coldness in the fingers and toes from narrowed blood vessels.
- Muscle pain or cramps, and a feeling of tightness in the chest.
- Rarely but seriously, dangerous narrowing of blood vessels affecting the heart, brain or limbs.
Key interactions
- It must not be used with triptans, as both narrow blood vessels and the combination is dangerous.
- Strong CYP3A inhibitors, including some antibiotics, antifungals and HIV medicines, can dangerously raise its levels.
- Other medicines that narrow blood vessels add to its effects, so tell your prescriber everything you take.
Available as: A solution for injection and, where available, a nasal spray.
Answers
Dihydroergotamine: frequently asked questions
What is dihydroergotamine used for?
It is an ergot medicine used to treat an acute attack of migraine or cluster headache, helping to bring an attack under control once it has started.
Can I use it with a triptan?
No. Both narrow blood vessels, so combining them is dangerous; they must be separated, generally by at least a day, on your prescriber's advice.
Why do my fingers go cold or numb?
It narrows blood vessels throughout the body, not just in the head, which can reduce blood flow to the hands and feet; report severe or persistent symptoms.
Can I use it in pregnancy?
No. Dihydroergotamine must not be used in pregnancy, so discuss reliable contraception and other options with your prescriber.
Why does it matter what other medicines I take?
Some medicines, such as certain antibiotics, antifungals and HIV medicines, raise its levels and can cause severe, prolonged vessel narrowing, so a full list is essential.
Authoritative sources
- BNF
- NICE CKS
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