Cluster headache ergotamine

Ergotamine Mixed partial agonist effects at 5-HT2 and (X adrenoceptors Causes marked smooth muscle contraction but blocks cx-agonist vasoconstriction Migraine and cluster headache Oral, parenteral duration 12-24 h Toxicity Prolonged vasospasm causing gangrene uterine spasm... 

Ergotamine can be an efficacious agent for prophylactic as well as abortive therapy of cluster headaches." A 2-mg bedtime dose is often beneficial for the prevention of nocturnal headache attacks. Daily use of 1 to 2 mg ergotamine alone or in combination with verapamil or lithium may provide effective headache prophylaxis in patients refractory to other agents with little risk of ergotism or rebound headache." - ... 

Corticosteroids are useful for chronic cluster headaches refractory to verapamil, lithium, ergotamine, and methysergide or combinations of these agents." Therapy is initiated with 40 to 60 mg/day prednisone and tapered over approximately 3 weeks. Relief appears within 1 to 2 days of initiating therapy. To avoid steroid-induced complications, long-term use is not recommended. Headaches may recur when therapy is tapered or discontinued. 

Ergotamine, an ergot alkaloid (2 mg snblingnally), is nsed to prevent or abort vascular headache, including migraine and cluster headaches (see also Figure 93). 

Cluster headaches are associated with abnormal dilatation of the carotid arteries, which can be constricted by ergot derivatives. In the cases cited it would seem that combined vasoconstrictor effects caused arterial spasm elsewhere in the body, resulting in serious tissue ischaemia. Parenteral ergotamine increases the risk of arterial spasm. 

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