Dihydroergotamine DHE

Dihydroergotamine (DHE) is available for intranasal and parenteral (IM, IV, subcutaneous [SC]) administration. Patients can be trained to self-administer DHE by the IM or SC routes. 

The effectiveness of dihydroergotamine (DHE) and ergotamine tartrate was demonstrated in old clinical trials which probably would not meet currently accepted criteria for good methodology. For ergotamine tartrate, the dose usually recommended is 1-2 mg/d not to exceed 6 mg/d or 10 mg/week. DHE, which has a low bioavailability, is only effective after parenteral administration (subcutaneous, intramuscular, intravenous, or nasal-spray administration). The recommended dose is 1-2 mg/d. 

There are some prophylactic treatments which are very individualized. Propanolol (p-blocker) has been used at 80-160 mg/day for up to 12 months. Methylsergide and dihydroergotamine(DHE), relatives of ergotamine, are used but have some serious side effects. Antihistamines such as cyproheptadine (Periactin ) have also been found to have tryptaminergic and anticholinergic activity in the CNS and can be used prophylactically. Calcium channel blockers have also been mentioned in an experimental vein. 

Example Dihydroergotamine (DHE, Ergomar with caffeine Cafergot) Route IM, SC, Intranasal Pregnancy category C Pharmacokinetic Slow incomplete absorption from GI tract metabolized in liver excreted in feces. 

Berard A, Kori S. Dihydroergotamine (DHE) use during gestation and the risk of adverse pregnancy outcomes. Headache Jul-Aug 2012 52(7) 1085-93. 

Key TPA, tissue plasminogen activator ASA, aspirin PT, prothrombin time APTT, activated partial thromboplastin time INR, international normalized ratio CBC, complete blood count IVIG, intravenous immune globulin SAH, subarachnoid hemorrhage IV DHE, intravenous dihydroergotamine CNS, central nervous system EEG, electroencephalogram BP, blood pressure EKG, electrocardiogram ICP, intracranial pressure TIA, transient ischemic attack. 

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