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

Updated: Nov 19, 2019
  • Author: Wendy G Mitchell, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA  more...
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Answer

Ergot Derivatives

Ergotamine preparations (alone or combined with caffeine) are direct vasoconstrictors of smooth muscle in cranial blood vessels. Their activity depends on the CNS vascular tone at administration. They also help establish the diagnosis. Ergot alkaloids should never be used to treat hemiplegic migraine.

Ergotamine (Ergomar)

Ergotamine is an alpha-adrenergic antagonist and serotonin antagonist that causes constriction of the peripheral and cranial blood vessels. Its effects are enhanced by caffeine. It is available as sublingual tab.

Dihydroergotamine (DHE-45, Migranal)

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

Dihydroergotamine is indicated for aborting or preventing vascular headache when rapid control is needed or when other routes of administration are not feasible. It is not approved by the US Food and Drug Administration (FDA) for use in children.

Dihydroergotamine is usually administered in conjunction with antiemetics such as metoclopramide (a 5-HT3 receptor antagonist and a dopamine antagonist) to treat migraine-associated nausea. Dihydroergotamine is available in IV or intranasal preparations, and it tends to cause less arterial vasoconstriction than ergotamine tartrate does.


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