The efficacy of the repetitive intravenous dihydroergotamine (DHE) inpatient protocol for refractory headache is wellestablished. We conducted a retrospective and prospective study of long-term headache patients at our clinic toevaluate this regimen in an outpatient setting.
Treatment consisted of oral metoclopramide and four doses of DHE, with the total dose equaling 4 mg.,administered over two days. Patients were followed for up to 10 weeks while they continued to receive prophylacticmedication. Responsiveness was rated in terms of decreased frequency or severity of headache: excellent (75% to100%), moderate (50–75%), mild (25–50%), and none (0–25%).
In the retrospective study, 69% (43/62) of patients with chronic daily muscle-contraction-type headache and severemigraine had an excellent response at two days. An excellent or moderate response was sustained over three weeks in65% (32/49) of the study group (13 patients were dropped from the study for failing to comply with record keepingrequirements). At the 6- and 10-week follow-up evaluations, the majority of patients (76% and 70%, respectively)reported mild or no relief.
Among patients with refractory daily headache or frequent severe migraine studied prospectively, 80% (28/35)reported an excellent response at two days. After six weeks, 66% (23/35) showed excellent or moderate relief. For bothgroups combined, 73% (71/97) of patients showed an excellent response to DHE at two days, with 43% (33/77)sustaining excellent or moderate relief at six weeks. Side effects, including nausea, leg cramps, facial flushing,increased blood pressure, diarrhea, burning at the injection site, and tightness in the throat and/ or chest, were generallymild and transient. Side effects were milder with outpatient DHE versus our experience with inpatient DHE.
Outpatient repetitive IV DHE treatment offers flexibility in the management of severe headache. Our studiesdemonstrate the safety and efficacy of this regimen.