From the Michigan Head Pain and Neurological Institute, Ann Arbor, MI (Dr. Saper); Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA (Dr. Silberstein).
Pharmacology of Dihydroergotamine and Evidence for Efficacy and Safety in Migraine
Article first published online: 27 OCT 2006
Headache: The Journal of Head and Face Pain
Volume 46, Issue Supplement s4, pages S171–S181, November 2006
How to Cite
Saper, J. R. and Silberstein, S. (2006), Pharmacology of Dihydroergotamine and Evidence for Efficacy and Safety in Migraine. Headache: The Journal of Head and Face Pain, 46: S171–S181. doi: 10.1111/j.1526-4610.2006.00601.x
- Issue published online: 27 OCT 2006
- Article first published online: 27 OCT 2006
- dihydroergotamine mesylate;
- ergotamine tartrate;
- migraine headache;
Dihydroergotamine mesylate (DHE), an ergot alkaloid, has been extensively utilized and studied in the treatment of episodic and chronic migraine. This article reviews the pharmacokinetics, pharmacodynamics, and clinical efficacy and safety of DHE, particularly in comparison to ergotamine tartrate (ET), a similar ergot alkaloid with a long history of use in the treatment of migraine. Structural differences between these 2 compounds account for clinically important distinctions in their pharmacokinetic, pharmacodynamic, and adverse event profiles. DHE is a significantly less potent arterioconstrictor than is ET, which makes it a potentially much safer drug. In addition, DHE is associated with a markedly lower incidence of medication-withdrawal headache, nausea, and vomiting than is ET. The safety and efficacy data presented here are derived from clinical trials and case series involving DHE administered by intravenous infusion, intramuscular or subcutaneous injection, or intranasal spray.