Ergotamine for migraine

The role of caffeine in migraine headaches is due to its vasoconstrictor effects. Caffeine is used in combination with ergotamine for migraine (Sawynok 1995 Sargent et al. 1988). However, discontinuation or missing a dose of caffeine after chronic use can precipitate headaches (Fennelly et al. 1991 Couturier etal. 1992). 

There is no evidence that ordinary use of ergotamine for migraine is hazardous in pregnancy. However, most clinicians counsel restraint in the use of the ergot derivatives by pregnant patients. 

Ergot alkaloids Claviceps purpurea Ergotamine for migraine Ergonovine for obstetrics... 

The lungs large, permeable surface makes systemic deUvery possible. For example, an inhaler deUvers 360 )Tg per dose of aerosolized ergotamine tartrate [379-79-3] for migraine (54), and inhalant systems deUver anesthetic gases. Research is under way on the systemic deUvery of proteins and peptides through the lungs (57,58). 

Ergotamine (Fig. 11) has medical uses for example it is frequently prescribed (often in combination with caffeine) as a therapy for migraine headaches. 

Hendrikx M, Van Dorpe J, Flameng W, Daenen W. Aortic and mitral valve disease induced by ergotamine therapy for migraine a case report and review of the literature. J Heart Valve Dis 1996 5 235-237. 

Hauck AJ, Edwards WD, Danielson GK, Mullany CJ, Bresnahan DR. Mitral and aortic valve disease associated with ergotamine therapy for migraine. Report of two cases and review of literature. Arch Pathol Lab Med 1990 114 62-64. 

Wilke A, Hesse H, Hufnagel G, Maisch B. Mitral, aortic and tricuspid valvular heart disease associated with ergotamine therapy for migraine. Eur Heart J 1997 18(4) 701. 

A 41-year-old woman developed worsening lower leg pain, pallor, and a sensation of coolness aggravated by exertion there was severe vasospasm in the legs (61). She had taken a caffeine + ergotamine formulation for migraine for many years and had recently been given clarithromycin 500 mg bd for flu-hke symptoms. 

Ausband SC, Goodman PE An unusual case of clarithromycin associated ergotism. J Emerg Med 2001 21(4) 411-413. [PMID 11728770] (Lower-extremity vasospasm due to addition of clarithromycin in a patient with longstanding use of a caffeine-ergotamine preparation for migraine.)... 

A 27-year-old woman was diagnosed with cervico-cerebral vasospasm and stroke after treatment with IV caffeine and ergotamine for status migraines. On hospital admission, she demonstrated a fluctuating level of consciousness and orientation with asymmetric spastic quadriparesis [33 ]. 

KoWer D. Aerosols for systemic treatment. Lung 1990 168(suppl) 677-684. Graham JR, Malvea BP, Gramm HF. Aerosol ergotamine tartrate for migraine and Horton s syndrome. N Engl J Med 1960 263 802-804. 

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