Parenteral Dihydroergotamine for Acute Migraine Headache: A Systematic Review of the Literature

Colman, Ian; Brown, Michael D.; Innes, Grant; Grafstein, Eric; Roberts, Theodore S.; Rowe, Brian H.

doi:10.1016/j.annemergmed.2004.07.430

Cited by 46 publications

(35 citation statements)

References 27 publications

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“…Figures 1, 2, 3 shows the time course of pain during the observation period. The choice of the drug, in the large majority of cases NSAIDs or paracetamol, according to medical history and characteristic of pain, was mostly influenced by the shortage of specific drugs, such as triptans [16], ergot derivatives [17], antiepileptic drugs [18], and narcotic analgesics [19]. Analgesic drugs have been mainly administered orally; the oral route facilitated the therapeutic management of patients after discharge and improved their compliance to treatment during the following 48 h.…”

Section: Discussionmentioning

confidence: 99%

Headache prevalence in the population of L’Aquila (Italy) after the 2009 earthquake

et al. 2011

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Stress induced by the events of daily life is considered a major factor in pathogenesis of primary tension-type headache. Little is known about the impact that could have a more stressful event, like a natural disaster, both in patients with chronic headache, both in people that do not had headache previously. The aim of the present study was to observe the prevalence of headache in the population following the devastating earthquake that affected the province of L’Aquila on April 6, 2009. The study population was conducted in four tent cities (Onna, Bazzano, Tempera-St. Biagio, Paganica). Sanitary access is recorded in the registers of medical triage, in the first 5 weeks, after the April 6, 2009. The prevalence of primary headache presentation was 5.53% (95% CI 4.2–7.1), secondary headache was 2.82% (95% CI 1.9–4.9). Pain intensity, assessed by Numerical Rating Scale score showed a mean value of 7 ± 1.1 (range 4–10). The drugs most used were the NSAIDs (46%) and paracetamol (36%), for impossibility of finding causal drugs. This study shows how more stressful events not only have an important role in determining acute exacerbation of chronic headache, but probably also play a pathogenic role in the emergence of primary headache. Also underlines the lack of diagnostic guidelines or operating protocols to early identify and treat headache in the emergency settings.

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Section: Discussionmentioning

confidence: 99%

Headache prevalence in the population of L’Aquila (Italy) after the 2009 earthquake

et al. 2011

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“…It is difficult to compare our data with those published for dihydoergotamine because, with only one exception in which it was found to be less effective than chlopromazine [13], this drug has been administered either by intramuscular route compared with subcutaneous sumatriptan, or associated with an antiemetic, usually metoclopramide which is known to exert an antimigraine activity of its own [14,15]. A recent systematic review of trials performed with dihydroergotamine concluded that, associated with an antiemetic, it seems to be as effective as the other active comparators, but underlined that the methodology and scientific quality of the trials was highly variable [15].…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review of trials performed with dihydroergotamine concluded that, associated with an antiemetic, it seems to be as effective as the other active comparators, but underlined that the methodology and scientific quality of the trials was highly variable [15]. …”

Section: Discussionmentioning

confidence: 99%

Efficacy and tolerability of intravenous methylergonovine in migraine female patients attending the emergency department: a pilot open-label study

et al. 2009

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BackgroundMethylergonovine is an ergot alkaloid widely used in postpartum women. It is also an active metabolite of methysergide and previous studies suggest that it could be effective against refractory headache and cluster headache. The purpose of the present study was to assess the potential therapeutic effectiveness of methylergonovine in the emergency treatment of severe migraine.MethodsOne hundred and twenty five female patients with migraine attending the emergency department received 0.15 mg of methylergonovine intravenously. Pain intensity, heart rate, blood pressure, and methylergonovine side effects were checked 5, 10, 15, 30 and 60 minutes after drug administration. An additional 0.075 mg dose of methylergonovine was administered to those patients who did not experienced relevant pain relief 15 minutes after dosing. ResultsPain intensity decreased markedly from the first minutes after dosing, the 74.4% of patients being pain free at 60 minutes. Only seven patients required an additional dose of methylergonovine. Nausea and vomiting were the most relevant side effects related with methylergonovine administration (84% of patients). A substantial decrease (10 to 25 mmHg) in systolic blood pressure values was observed in 56% of the patients. A significant correlation (p < 0.0001) was found between the decrease in pain intensity and the reduction of systolic blood pressure.ConclusionAlthough limited by the non-controlled design of the study, our data suggest that intravenous methylergonovine can be an effective and safe drug in the management of severe migraine attacks in the emergency room.

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“…Similarly, DHE is less emetic than ergotamine (dopamine D2) [23]. DHE can be used parenterally [30] or by the nasal route [23,24] in the treatment of migraine attacks. For adverse potential events of DHE, see ref.…”

Section: Ergot Alkaloidsmentioning

confidence: 99%

Acute pharmacotherapy of migraine, tension-type headache, and cluster headache

Tfelt‐Hansen

2007

J Headache Pain

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In most migraine patients acute therapy is needed. Migraine can be treated either with specific drugs, the triptans and ergot alkaloids, or with NSAIDs. Triptans are a major step foreward in migraine therapy. The therapeutic gain for headache relief is 50% for subcutaneous sumatriptan whereas it is 30-40% for most oral triptans. After oral triptans sustained pain free is only 30%. There is thus still ample room for improvement of acute therapy in migraine. For tension-type headache there is no specific therapy and it is treated with NSAIDs. Only 17-32% become pain free after these drugs. For attacks of cluster headache oxygen and subcutaneous sumatriptan can be used. Intranasal triptans can be an alternative.

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Parenteral Dihydroergotamine for Acute Migraine Headache: A Systematic Review of the Literature

Cited by 46 publications

References 27 publications

Headache prevalence in the population of L’Aquila (Italy) after the 2009 earthquake

Headache prevalence in the population of L’Aquila (Italy) after the 2009 earthquake

Efficacy and tolerability of intravenous methylergonovine in migraine female patients attending the emergency department: a pilot open-label study

Acute pharmacotherapy of migraine, tension-type headache, and cluster headache

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