Exacerbation of headache during dihydroergotamine for chronic migraine does not alter outcome

Eller, Michael; Gelfand, Amy A.; Riggins, Nina; Shiboski, Stephen; Schankin, Christoph; Goadsby, PJ

doi:10.1212/wnl.0000000000002406

Cited by 19 publications

(8 citation statements)

References 12 publications

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“…4 A significant proportion of patients undergoing DHE infusion also report worsening headache. 1,3 A similar phenomenon has been described with triptan use. 5 This may prompt clinicians to prematurely terminate the intervention, potentially depriving patients of the full benefit of DHE infusion.…”

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confidence: 53%

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Journal Club: Exacerbation of headache during dihydroergotamine for chronic migraine does not alter outcome

et al. 2016

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Transient headache exacerbation during IV dihydroergotamine (DHE) therapy of migraine may prompt clinicians to prematurely discontinue DHE therapy, potentially depriving patients of the full benefit of DHE infusion. In a recent Neurology ® article, Eller et al. evaluated whether or not worsening headache during DHE infusion was associated with suboptimal medium-term headache outcomes. Neurology ® 2016;87:e196-e198 This Journal Club reviews an article by Eller et al.

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supporting

confidence: 53%

“…INTERPRETATION Based on their study, Eller et al 1 concluded that headache exacerbation during or within 30 minutes of DHE infusion should not mandate for infusion discontinuation. The authors made this conclusion based on the absence of association between DHE infusion headache exacerbation and medium-term headache outcome.…”

Section: Methodsmentioning

confidence: 99%

Journal Club: Exacerbation of headache during dihydroergotamine for chronic migraine does not alter outcome

et al. 2016

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“…The goals of inpatient headache treatment will vary based on the indication for admission. 84 IV lidocaine infusion is available in some hospitals and headache centers. Ideally, patients should maintain headache freedom for at least 72 hours after treatment.…”

Section: Expert Opinionmentioning

confidence: 99%

“…A transient exacerbation of headache may be experienced by some patients receiving DHE; however, this does not alter the overall response to treatment and should not be taken as an indication to stop treatment. 84 IV lidocaine infusion is available in some hospitals and headache centers. It is most commonly used for adult headache treatment; however, children with SM have shown benefit from it as well.…”

Section: Expert Opinionmentioning

confidence: 99%

Status Migrainosus in Children and Adults

2019

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“… 1 , 2 The most common side effect of DHE is nausea, and its control is associated with better treatment outcomes. 2 , 3 Indeed, nausea and vomiting control is a practical and common issue in emergency departments in the management of acute migraine.…”

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confidence: 99%

Aprepitant for the management of nausea with inpatient IV dihydroergotamine

2016

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Objective:To assess the efficacy and tolerability of oral aprepitant, a substance P/neurokinin A receptor antagonist, in controlling nausea associated with IV dihydroergotamine (DHE) administered for medically refractory migrainous headache in patients not responding to standard antiemetics or with a history of uncontrolled nausea with DHE.Methods:This was a retrospective chart review of prospectively collected hourly diary data and clinical notes of patients hospitalized between 2011 and 2015 for inpatient treatment with DHE. Patients were classified using the International Classification of Headache Disorders, 3rd edition (beta version). Peak and average daily nausea scores from hourly diaries, or daily entries of notes, and concurrent antiemetic use were collected and tabulated.Results:Seventy-four patients, of whom 24 had daily diaries, with chronic migraine with or without aura, with or without medication overuse, or new daily persistent headache of a migrainous type, were identified. In 36 of 57 cases in which aprepitant was administered during hospitalization, there was a 50% reduction in the average daily number of as-needed antinausea medications. Of 57 patients, 52 reported that the addition of aprepitant improved nausea. Among 21 of 24 patients with hourly diary data, nausea scores were reduced and in all 12 with vomiting there was cessation of emesis after aprepitant was added. Aprepitant was well tolerated with no treatment emergent adverse events.Conclusions:Aprepitant can be effective in the treatment of refractory DHE-induced nausea and emesis. Given the broader issue of troublesome nausea and vomiting in acute presentations of migraine, general neurologists may consider what place aprepitant has in the management of such patients.Classification of evidence:This study provides Class IV evidence that for patients with medically refractory migraine receiving IV DHE, oral aprepitant reduces nausea.

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Exacerbation of headache during dihydroergotamine for chronic migraine does not alter outcome

Cited by 19 publications

References 12 publications

Journal Club: Exacerbation of headache during dihydroergotamine for chronic migraine does not alter outcome

Journal Club: Exacerbation of headache during dihydroergotamine for chronic migraine does not alter outcome

Status Migrainosus in Children and Adults

Aprepitant for the management of nausea with inpatient IV dihydroergotamine

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