Which medications in the drug class Ergot Derivatives are used in the treatment of Migraine Headache?

Updated: Oct 21, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
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Ergot Derivatives

Ergot derivatives are nonselective 5-HT1 agonists that have a wider spectrum of receptor affinities outside of the 5-HT1 system, including dopamine receptors. They can be used for the abortive treatment of moderately severe to severe migraine headache.

Ergotamine tartrate (Ergomar)

Ergotamine counteracts episodic dilation of extracranial arteries and arterioles. It has partial agonist and/or antagonist activity against tryptaminergic, dopaminergic, and alpha-adrenergic receptors. Ergotamine causes constriction of peripheral and cranial blood vessels. The drug is available in a sublingual dosage form.

Dihydroergotamine (DHE-45, Migranal)

Dihydroergotamine (DHE-45, Migranal)

Dihydroergotamine is an alpha-adrenergic blocking agent with a direct stimulating effect on smooth muscle of peripheral and cranial blood vessels. It depresses central vasomotor centers. Its mechanism of action is similar to that of ergotamine; it is a nonselective 5HT1 agonist with a wide spectrum of receptor affinities outside of the 5HT1 system; it also binds to dopamine. Thus, dihydroergotamine has an alpha-adrenergic antagonist and serotonin antagonist effect.

Dihydroergotamine is indicated to abort or prevent vascular headache when rapid control is needed or when other routes of administration are not feasible. It tends to cause less arterial vasoconstriction than ergotamine tartrate. It is usually administered in conjunction with antiemetics such as metoclopramide, which is a 5HT3-receptor antagonist and a dopamine antagonist, to treat migraine-associated nausea.

Dihydroergotamine is available in intravenous, intramuscular, subcutaneous, and intranasal preparations. The intravenous route is used when more rapid results are desired. A dose of 1 mg intravenously every 8 hours with or without metoclopramide is safe and effective for treatment of status migrainosus.

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