To evaluate the effectiveness of repetitive intravenous (IV) Dihydroergotamine (DHE) in patients who had prolonged infusion time via retrospective record review.

DHE has been shown to provide relief in acute migraine as well as in chronic migraine and status migrainosus. Repetitive doses of IV DHE during 5 days inpatient admission have been shown to produce improvement in headache and disability in patients with chronic migraine.

Antimigraine efficacy is thought to be due to agonist activity at 5-HT1B/1D/1F receptors. DHE also has agonist activity at 5-HT1A/2A and dopamine D2 receptors, which can cause side effects including sensation of leg and stomach cramps. 

In our experience, one of the most effective ways to manage unpleasant side effects of DHE is to slow the infusion from 60 minutes to 90-120 minutes.

Electronic medical records and Headache diaries were reviewed from one month before, and four to eight weeks after admission.

48 participants with chronic migraine admitted for inpatient IV DHE were included. 

17 of 48 patients had infusion slowed for the specific side effect of cramping (35%).

12 out of 17 patients (71%) had an improvement in their headache status post-admission and reported a reduction in headache frequency, intensity and/or use of acute medications four to eight weeks following their admissions. 

Previous studies using the same protocol for administration of IV DHE (with infusions over 60 min), demonstrated 69-75% improvement.

Prolongation of infusion time to manage cramping led to improvement of side effects, but did not interfere with efficacy of the treatment.

Future randomized studies need to be done to see if IV DHE over 90-120 min can proactively reduce side effects in all patients undergoing IV DHE admission without decrease in efficacy.