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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I can relate to so much of the suffering that others have shared here. I’ve not tried DHE, but don’t think I’m a candidate as I have Raynaud’s. I’m on Neurontin presently, but continue to have chronic migraines. Sometimes I have nausea and dizziness with a moderate headache, but always have an aura if I go outside without sunglasses. The only thing that helps is larger doses of prednisone. I even went through chemotherapy because my doctor thought the headache was lupus related. No relief.
I’m very frustrated. I’ve recently had botox injections but I still cannot work. I have no income, and would probably not qualify for disability due to family income. When I applied in 2002 they told me I could be a medical assistant instead of an RN! Unfortunately I didn’t appeal (I was DISGUSTED at such idiocy). I am no longer eligible for anything temporary because I haven’t worked in so long. Don’t know whether to try a second round of botox.
FRUSTRATING!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
I have a 14 year old with CVS( cylic vommiting syndrome. This DHE we tried in January , 72 hours iv therapy. Today will b her second trip. This scares me. She hurts and crys the entire time, but she didn’t have an attack for 7 months. For her CVS this therapy seems to work. She does have major high anxiety, Not being treated for at this time, which we know brings on these attacks, which may last up to eight weeks in bed. Worse case.
My spouse was admitted to UCSF, getting DHE IV after doing 4 days detox off a lot of opioid pain medicine and triptans, and he is tolerating it well and is the most awake, nausea and pain free he’s been in many months, having had a headache every day in the last year.
The doctors there believe that opioid pain medicine can interfere with the ability of other medicines to prevent migraine.
He was very resistant to trying to go off opioids and triptans, but so far he is doing amazing.
Apparently the DHE treatment is a one-time deal to “reset” the brain and break the headache cycle. Some patients repeat it after 6-12 months, but you can get medicine overuse headache from DHE (like triptans, aspirin, and opioids), so it’s better to use it as a reset button.
Someone recently told me about a procedure where blood (patient’s won) is injected into the muscles (I think) in the neck. Has anyone heard of this treatment?
My daughter whom I spoke of before had the dhe treatment in September. She almost died due to wrong medication being given per doctors orders. Her blood pressure bottom out. 5-8 more weeks of hospital stays to get her straighten out. Episodes have increased. SHE will NEVER go through another dhe treatment. Good luck to those it does work for.
One mored comment. My daughter is now 15 and was passing out, way more migraine attacks and CVS. After dhe treatment was having chest pains, had to wear heart monitor for one month. Still having chest pains, still sick,(worse now). Just simply put can not function..I’m very angry DHE made things way worse the second time. No child should have to live like this. Does anyone know where else to go for treatment of some kind. DESPERATE for a solution.
Jan,
Has your daughter tried Periactin? It is generally used in children for migraine. The bad side effect is weight gain, as this medication is also used to treat anorexia. Periactin is the only thing, besides large doses of prednisone, that has helped me, and I’m an adult. Don’t like the weight gain but it is the only thing that has allowed me to be more functional. I’m hoping to be able to go back to work.
excuse my ignorance but could someone tell me is DHE an injection of dhyldergot which is a pain relief for migraine
Dear Jan,
So sorry to read of your daughter’s experience. My son had a similar experience with dhe. We have a friend who had success with the diamond clinic in chicago. You might check there. I would not give her kolonopin. They don’t always mention the pediatric rage side effect.
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