To get some background on DHE migraine treatment, we need to go back to the days before DHE, or dihydroergotamine, was used. It was actually in 1925 that the first migraine patient got an injection of ergotamine tartrate. It worked – stopping the migraine that just wasn’t going away.
In 1943 came the next step for "ergot treatment" – DHE, the long name being dihydroergotamine. It was first used at the Mayo Clinic.
Yes, 1943.
Since then, our understanding of migraine has been completely transformed. And yet, some people are still using DHE to stop migraine attacks. Why?
Earlier this week I asked on Twitter who had used DHE lately, and got a helpful response from @maxjerz, who had used IV treatment to stop a migraine that, again, was not going away – 24/7 pain.
 Photo courtesy of BlueGoa |
That answer is actually typical – DHE is often given for migraine attacks that aren’t being stopped using more common medication. DHE IV therapy isn’t the only way to go – it can also be injected intramuscularly or subcutaneously. I’ve used it myself, and let me tell you sticking a needle in your body when you’re more sensitive to pain than ever isn’t fun (and for me wasn’t any help) (read Robert’s experience with DHE).
Just last month a report came out of the Cincinnati Children’s Hospital Medical Center in Ohio, USA about using DHE migraine treatment on children and adolescents with status migraine (again, migraine that ain’t going away – an attack lasting more than 3 days). The results were encouraging – almost 3/4 of the patients became pain-free (excellent considering their normal medication wasn’t working). Read the study on DHE migraine treatment for children and adolescents.
So DHE (sold as DHE-45 and Migranal) is still given to patients who aren’t being helped by other medications, and because it’s an injection it can be used for patients who have nausea. It also may help with allodynia (sensitive/painful skin – a common symptom of migraine).
So – why don’t MORE people use it?
So maybe our question should be – why isn’t DHE migraine treatment used more often? Here’s why dihydroergotamine is no longer at the top of most doctor’s lists:
- Side effects: Serious side effects are rare, but they’re serious enough to make one cautious. Possible problems include cardiac events, increase in blood pressure, and spasms of blood vessels.
- Drug interactions: There are a large number of drug interactions that you need to worry about with DHE, such as certain antibiotics, triptan drugs, and protease inhibitors. It’s recommended you carefully go through any drugs you’re taking or may take and let your doctor know before using DHE migraine treatment.
- Other cautions: Like many drugs for migraine, DHE can’t be used by pregnant or nursing mothers. There’s also concern about patients with hypertension, certain types of migraine, and patients with peripheral arterial disease (to name a few).
- Rebound headache: Taking DHE may lead to rebound headache, where the migraine attacks start coming stronger and faster because of the medication itself.
Obviously other drugs have many side effects, and other cautions, but the concerns with DHE may be higher compared to the benefit, depending on the patient. For most people, other treatments will work better. But a doctor who knows your medical history may suggest DHE for your case individually.
So, although your doctor will have good reasons for recommending other medications first, DHE may still be the perfect thing to end the migraine symptoms in certain patients.
Read more technical details about dihydroergotamine msylate here.
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{ 24 comments… read them below or add one }
Years ago my neurologist suggested that I try DHE as a preventative. I don’t remember how much I was taking, but I developed severe leg pain (probably a vascular thing). This seemed to be dose related, so I continued to use it as an abortive. And, you guessed it, MOH or rebound headaches. Not a drug I am interested in taking again.
Oh dear, double trouble! It didn’t really do much of anything for me. I just remember how sensitive to that needle I was during an attack!
I just started taking DHE in January. So far, so good. It is helping me, and it may be too soon to know if I have rebound problems. I have tried almost everything else (no exaggeration).
I was admitted to the hospital last summer to try DHE. For the first time in three years I woke up without a headache, after one day’s treatment. As Andy stated, I had tried everything.
My neurologist stopped all of my other treatments, and started me on DHE via IV. The only problem is that DHE can be horrible on your veins. The nurses would put in an IV, administer the DHE, and then stop the IV — leave in the tube without fluid flowing through. This resulted in my blood vessels collapsing the next time they went to administer DHE. After five days in hospital my arms were black and blue and really sore — though I was headache free.
Once released from the hospital my doctor prescribed it for me to inject intramuscularly. I am allowed to inject 1 mL/mg up to three times a day. I generally don’t use it more than twice a day, but do use it once on most days.
I find it very difficult to inject it in my thigh when I am in a full blown migraine. Added to that is the fact that my preventative medication, Divalproex, causes tremors, I can be a mess. My husband is kind enough to inject it in my gluteous maximux if I can’t do it myself.
I haven’t had any pain in my legs and I don’t know if I’m getting rebound headaches … it’s possible, but I’m not having to increase the dosage constantly as I had to with narcotics. If I’m experiencing rebound headaches I can live with that … it’s far better than codeine or morphine, both of which caused horrible rebound headaches and in the end didn’t work. Now I can use codeine occassionally to fix the migraines that don’t work with DHE.
i was hospitalized in septembert of 2008 with a bad migraine.My doctor put me on DHE and i was in hosital for almost 2 weeks. It didnt do much for my headache. In Novembert of 2008 i was hospitalized again because migraine wouldn’t go away. They ended up puting in a pickline and putting me on DHE again. Within a few days i ended up in ICU with convultions, pneumonia (they have no idea what type) and congestive heart failure. Needless to say i can no longer take DHE and would not recommend it to anyone. Even my regular md said that I crashed fast and hard and suprised everyone. Now I have to live day to day wondering when my next seizure is gonna hit. But the real kicker is I still have the migraine going on 6 months.
My neurologist has recommended the DHE treatment for me. I’m waiting to see if the insurance will approve it first. After reading your comments not sure I want to try it. I have a history of a seizure disorder. I had epilepsy brain surgery in 2002, and lord knows I don’t want the seizures to start back again!
Thanks for sharing your experiences. Some of the biggest concerns with DHE concern your cardiovascular system – from a rise in blood pressure to “collapsing” blood vessels (vasospasms if you want to make it sound impressive).
But if your doctor is aware of your medical history, and you’re under her care, it seems DHE can still help some people get out of some severe cycles of pain.
i have had to take relpax and D.H.E. and did iv treatment for 8 days in hospital. had to take injections for myself if relpax did not work. i have not once had any relief from the injections I have had to take if relpax failed. relpax actually works better. do not take d.h.e. it’s has too many bad side effects.
Hello, I turned to a neurologist in Tulsa in 2000 due to migraine headaches. After CT scans MRI’s and an array of other tests that proved everything was fine, still the many medications that use to releive the pain no longer worked. He recommended the DHE treatment in the Hospital for 7 days. IV every 8 hours. My viens did collapse and I do not even remember the first 3 days in the hospital. They were giving me an array of other medicaions with this for some reason. My husband requested a list of these medications when I was incoherent and questioned what they were and why and they discontinued many! *I had thought I was only having the DHE however they were also giving me other medications that I did not previously take. After my husband got the unheard of medications stopped I was awake. I had a headache until the 6th day and it was only very slight. I could not take any more of the IV’s and I insisted on leaving. I do not have a migraine every day. I am able to use maxalt now or imitrex. I no longer need imitrex shots and am not going to the emergency room for a shot of tordol and phenergan. I am able to function with a pill now as where before I was ordering Imitrex through mail order by the case! At times I am even able to use Excedrin Migraine! The hospitalization was a rough experience. During the hospitalization they did have me seek biofeedback, a nutrion doctor and taught relaxation techniques. I feel the DHE treatments were successful, however, I do not wish to ever go through that again. The doctor explained it would be like restarting a thermostat, so regular medications would work since NOTHING was working. It did exactly as they said it would. Best of Luck to ANYONE undergoing this. Make sure you have someone you trust to oversee you in the hospital.
I have had migraines since high school and only to increase i severity to now as I am 43. I have exhausted doing countless meds and am currently off narcotics (except for ER visits) and use DHE as an injectable. My headaches are so frequent and severe and increasingly worse with symptoms. My doctor has mentioned doing the week long DHE in the hospital scenario, and I go in to see him tomorrow. I think I am finally at the point where I am willing to do it. Scared of the vein problem possibility, in the past for visits over 3 days I have had to have a pic line/mid line placed…. wonder if that would happen again or even make those lines worse? And unfortunately he is not on my insurance, so getting coverage on this and even in a timely manner is concerning. Thank you for letting me post here.
Well, I’m sad to report that my experience with DHE took a turn for the worse. About four months ago I started having difficulty breathing. It began with a bad cough and then progressed to chest pain and fluid in my lungs. By the end of August I could barely walk two feet without becoming short of breath.
I went to the emergency room three times and was admitted to the hospital two times. At first the doctors said it was a virus, then a pulmonary embolism, and then asthma. The cardiologist finally figured it out last week when I went in for an echocardiogram. I have a leaky mitral valve and have been in congestive heart failure for the past several months.
The doctors stopped the DHE and started me on cardiac medications. My symptoms cleared up almost immediately. The doctors are hopeful that my heart will heal itself now that I’ve stopped DHE, however, if it doesn’t I will need surgery.
I’m struggling because my migraines are back with a vengence without DHE. I’m trying triptans again and oxygen — it worked well in the hospital.
Part of the difficulty in diagnosing my problem is that I’m 38 years old — generally too young for mitral valve issues — have no history of heart problems, and my echocardiogram from six months ago was completely fine — again generally not seen to happen that fast.
I’ve also been diagnosed with sleep apnea and using a CPAP machine at night has been helping with morning migraines.
Best luck to everyone.
I also used DHE except it was in nasal spray for called Mirgranal. Both times that I use it at onset of migraine and both times ended up at the ER vomiting with the worst headache that I ever had. Beleive me I never used that again. I have been diagnosised with intractable migraines along with chronic daily headaches. I must have tried everything under the sun including naturapathic medicine and nothing works. I had to retire from my job, because I could not function. I would occasionally get a migraine, but then after I had a hysterectomy they got 100 times worse. I would NOT advise anyone to use DHE or Migranal I think that they are to dangerous.
well all of your information has been informative as i hope mine will also be…..i have had migraines for about 3 years and just finished my first DHE IV treatments 3 days ago. i dont think i will ever do it again. my migraine is gone but 2 days later i woke up with the WORSE migraine i have ever had so bad i landed in the ER. i was hoping in was just a rebound headache from the DHE. its now 3 days later and im still so dizzy i can barely walk from my living room to my kitchen without passing out! im so frustrated i dont know what to do. i have just about exhausted most of my sick time and my employer is not very understanding of someone with “just a headache”! i wish the would find something to take that would held break the cycle of pain for us all!!
I have been taking DHE for about 3 years now. Only use it every few months for the worst headaches. I self inject (it burns like hell) but when I have the worst migraines, I don’t even care anymore. It definitely helps abort the migraines that have been going on for days. I usually end up sleeping afterwards. The only side effect that I personally have from it is that my whole body is sore (like I ran a marathon) for about a day afterward. Honestly, if I can get rid of the migraine, it doesn’t matter to me. Just make sure that if you are taking triptans to abort a migraine (ex relpax) don’t take it within 24 hours of the DHE. This can cause dangerous cardiac arrythmias. Everyone has the possibility of reacting differently to every medication. I got my first dose of DHE in the neurologists office and felt a million times better afterward. My only problem now is getting it covered by insurance!
Hello,
I suspect my cardiac problems arose because I was using the DHE daily for my migraines. A positive result of my story is that during the year I was using DHE I reduced the amount of pain relievers I was taking (i.e. tylenol with codeine). This break has made it possible for me to manage the migraines with occassional triptan use, aspirin, and rarely tylenol with codeine.
My heart is healing itself now that I have stopped taking the DHE. I am no longer short of breath, or have a racing heart. The murmur is still present, but I suspect that will go as my heart heals. I have been able to ween back on the hard medications I was prescribed in August because of the improvements with my heart.
Hello , Well I have had migraines for a while now. I have my regular neuro here in NJ and a neuro in NY City as well. I have had DHE IV in the hospital say 5 times. Works like a charm for me. I have say a 3 day hospital stay have it with some IV Zofran for the nausea. Only thing is I have low heart rate so the DHE lowers it more for me I go to the 40 to 50′s as a result so I am put on a telemetry floor to monitor my heart rate but I am feeling fine on it just tired… as far as the veins yes it burns after a few treatments sometimes I end up needing a new line but its ok with me hey the pain goes froma 10 to a 1 by the 2nd day. My problem is once I am discharged after the first day home I start getting my migraine back. I am on preventatives such as verapamil,toapamax, indomethacin… I just started taking dhe by mouth when the pain comes instead of the triptans cause they werent helping me much and I ended up over using. I want to try the injectable DHE doctor is hesatating I think, also my NYC doc is looking into Botox waiting for insurace to say ok. Well oh also when I go in to the ER for treatment I receive Dialudid and Benedryl well works like a charm at the moment but next day is 100 times worse terrible and my docs tell me if they are your friends there they wont give you narcotics they are bad for you!!! See I work there thats why they say that
I have been having daily migraines for about 5 months now. I’ve had many tests with no success at finding what is causing them. I just discussed the possibility of DHE with my dr. today. I have to say though, that after reading all of these, I am not so sure that’s the way to go. Yes, I want and need relief, but at what other health risks it could lead to? I know that all medications come with their own side effects, this one just seems to have to many severe ones. Thanks for sharing your stories and helping me make my decision.
I have been a life long migraine sufferer. I recently completed a five day hospitilization where I recieved DHE as well. They did put in a pic line, and I was given glucose between treatments, I assume to prevent collapsing veins. I was also given an anti nausea medication at the same time. I was urged to take it easy and it might take a few weeks to see results. After two weeks, my headaches completely stopped! Its been nine days so far, but I feel so clear and different.
I think the Headache Program at UCSF is a first rate program.
Seven years ago, our 15 year old daughter was taught to self-inject DHE to stop a three-week cycle of migraines that had her in the hospital. WIthin three days she lost all circulation below mid-thigh and was pregangrenous. The vascular surgeon was horrified at the damage done by the DHE, which the neurologist defended as an “aggressive rescue remedy”. SHe spent ten days in pediatric ICU with cardiac meds being poured into her to reverse the damage, and then she needed to learn to walk again. SHe has permanent damage to her toes. We can’t sue because in our state, the doctor needs to have been intentionally negligent to be sue-able.
Please don’t take this medication. It’s just not safe.
Mary,
I am so sorry to hear about your daughter. I’m glad they figured out what was affecting her and you were able to stop it. I was very scared at 38 being told I might need to have a valve in my heart replaced. I struggle because my migraines are back with a vengence. I’m doing my best to manage them with a varied cocktail of migraines. It’s a rough rode. I wish there was more being done to find a cure because it’s a tough disease to live with.
My thoughts are prayers are with your family.
Nickie
I was hospitalized for 3 days of dhe after 30 days of migraines that nothing could stop, it was the best thing I ever did, I had clarity within a few hours I had never had before, it was amazing. I cannot wait to try it again!
Angie, I’m glad to hear you got some relief and clarity. I hope you don’t run into the problems that some of us have. It seems that if you use it daily you’re at a higher risk. The information I’ve read seems to indicate once in a while is okay.
Nickie
I give myself the dhe injections subQ when my migraines are bad enough up to twice a week no more then 3 times a day .5 milligramas. I have had it in the hospital IV and my neuros in NJ they just freak out over it because well its a serious drug and my heart rate drops and I become flush. Now that I give myself it at home from my NYC neuro I can forget about getting it in the hospital because of toxcitity. It somtimes works but not as well as getting in IV. I took i milligram once and had leg spasms and had to get a doppler of my leg but it was a side effect everything was fine. Just need to stick with low dose. If i get the migraines more frequent I wind up in the ER with pain meds which cause rebound sometimes can’t win but I am in the process of getting Botox at my docs in NYC so I have my fingers crossed that will work. I wish everyone the best and I truely believe no one understand the pain we go threw unless you suffer from these.
I’ve suffered chronic migraines for 13 years since my brain anyerism rupture and 2 clippings. My neuologist has prescribed everything on the market, but DHE injections as an abortive, is the only relief that I’ve found. I inject in my thigh and take a cocktail of doxipin, seroquel, compazine and bufferine. After around 1 hour of pain and nausea I pass out for 5 or 6 hours. The DHE meds make me drugged and drousy for 1 to 2 days following the attack. I also take topamax and atenalol along with lexapro daily. I’m tired….I’ve spoke with a new dr. about Botox injections for migraines, but they are so…expensive and have to be repeated often. Good Luck to All