DHE

2 May 2019

New Approaches to “Aggressive” Migraine Treatment

Migraine symptoms are sometimes “endured” for months or years without serious focus on treatment. Many people are being told that migraine is “normal” and that they just have to “put up with it” and “take an aspirin” (not that aspirin is always a bad idea).

Aggressive Migraine Treatment at the Hospital — Aggressive migraine treatment often requires hospitalization…

There are other patients who have tried many treatments, and are still, or now, experiencing several headaches a week, or almost constant migraine symptoms. And so “aggressive” treatments are finally tried.

One such aggressive treatment is used for children and teens as well as adults who haven’t responded to many of the most effective drug or even surgical treatments. It’s intravenous dihydroergotamine (DHE) therapy.

This is a serious, aggressive therapy because it generally involves hospitalization. Patients are given DHE every few hours (perhaps 3 times a day).

Results of this kind of treatment have been quite positive. Not only are many patients much better or even headache free at the end of the treatment, the improvement is often sustained for many months afterwards. (A couple of quick examples – see Repetitive intravenous dihydroergotamine as therapy for intractable migraine. and Inpatient treatment of status migraine with dihydroergotamine in children and adolescents.)

In spite of the positive results, one of the biggest drawbacks to this treatment is that full hospitalization is very expensive.

But trying to take the treatment to the next level, some specialists in Kansas City are using what they call the “Comprehensive Aggressive Migraine Protocol”, or CAMP. This is a 5 day treatment protocol for 11-18 year old patients. CAMP aims to make two major improvements:

This is “outpatient” treatment, so full hospitalization is not required.
Instead of full focus on DHE, the DHE treatment is combined with other treatments, such as massage therapy, relaxation training, and aromatherapy.

This type of treatment may not only save money, but also save on the extra stress of full hospitalization, as well as the possible stress of having the full focus on the intravenous DHE treatments. Also , it helps the patents take control of their condition by learning techniques that they can use at home in the months ahead. Finally, it brings a number of treatments together, which could mean better long-term success.

CAMP was the focus of a recent study, and here are the results

On average, headache intensity declined by 58% over 5 days of treatment (P<.01). Headache frequency decreased by a mean of 1.5 days per week (p=.01) through 3-month follow-up, with a 27% reduction in the proportion of patients reporting a continuous headache (p<.01). There also was an average reduction of 76% in school days missed per month (p<.01) and significant reductions in indices of healthcare utilization (healthcare provider calls and ED visits) (p<.01).
Enhancing outpatient infusion with interdisciplinary care to manage refractory pediatric migraine: Preliminary outcomes from “CAMP” (the Comprehensive Aggressive Migraine Protocol) (P3.10-016)

One statistic alone – the 76% decrease in missed school days – should get our attention. That’s pretty significant.

Sometimes migraine does require “aggressive” treatment. This study reminds us that there are times when we should consciously take time out of “normal life” to really focus on serious treatment, because the benefits for ourselves and those we love in the months and years ahead can be very significant.

Aggressive treatment may take many forms, and one way specialists can help is by giving options to migraine patients – protocols of well-researched and carefully planned treatments, that can break the cycle of migraine symptoms.

Learn more about Dr. Jennifer Bikel, the study’s lead author, here. Read more about DHE treatment in general here.

13 February 2015

Whatever Happened to Levadex?

James Medications, News 1

We’ve been talking about the new migraine drug, Levadex, since 2010. But it’s still not on the market. Will it ever be?

Levadex was still in the news last year, but under a brand new name. Semprana is the new name for Levadex, a new formulation of dihydroergotamine mesylate (DHE). It’s now owned by Allergan, the makers of Botox.

Semprana is an inhaled migraine abortive. It looks especially promising for nausea, and sensitivity to light and sound.

But last summer, Semprana was rejected yet again by the FDA in the United States. That’s the third time. The good news is that the rejection had nothing to do with whether or not Semprana works, or whether or not it’s safe. Instead, the FDA had technical concerns about the manufacturing and functioning of the device.

Semprana remains in Allergan’s pipeline, and is still looking like it could be a big player in the migraine market. But consumers probably won’t be seeing it in the local pharmacy until 2017.

6 February 2015

The Best Medication for Migraine? The AHS Reports

James Discoveries & Stats, Information, Medications 0

Last month the American Headache Society came out with a new report suggesting which drugs have the best evidence behind them when it comes to migraine. According to the trials, what works the best?

Best Meds 2015 This, of course, does not mean that these medications will work the best for you. There is a lot of variation within migraine, and your doctor will help you decide where to start.

However, if your doctor isn’t talking about some of the treatments at the top of the list, you should be asking some questions.

The full report can be found here: The Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies. However, here is a summary of some of the authors’ findings.

The medications with the best evidence behind them included:

The Triptans: Certain specific triptan medications were mentioned, such as almotriptan, sumatriptan, and naratriptan
Butorphanol nasal spray
NSAIDs: aspirin, diclofenac, ibuprofen and naproxen
Acetaminophen, but only for “non-incapacitating attacks”
DHE
Acetaminophen/aspirin/caffeine combo
Sumatriptan/naproxen combo

Some of the medications that really don’t have good evidence behind them, or the evidence is conflicting at this time, include:

Lidocaine IV
Celecoxib
Hydrocortisone IV

This is only a portion of the list – most medications fall between these two extremes. Also, it’s important to note that the researchers noted actual dosages, which means of course that any particular medication may work better/worse at a different dosage, but it may not have been studied.

Also, remember that these are only “acute” medications – taken at the time of an attack – not preventatives.

The conclusion of the study offers an appropriate warning:

According to this systematic review of the literature and structured grading of the evidence strength, specific medications within the following classes are considered “effective” for the acute therapy of migraine: triptans, ergotamine derivatives, NSAIDs, opioids, and combination medications. Several other medications are considered “probably effective” or “possibly effective.” This evidence base for medication efficacy should be considered along with potential medication side effects, potential adverse events, patient-specific contraindications to use of a particular medication, and drug-to-drug interactions when deciding which medication to prescribe for acute therapy of a migraine attack.

17 April 2013

Levadex – Rejected Again

James Medications, News 2

Levadex, an inhaled version of dihydroergotamine mesylate (DHE), has been rejected again by the FDA in the United States due to manufacturing concerns.

Levadex was recently at the centre of a deal worth almost a billion, when Allergan bought MAP Pharmaceuticals, the developers of the drug. Just over a year ago, with MAP at the helm, Levadex was not approved by the FDA due to concerns about the inhaler.

Allergan is probably best known for manufacturing Botox, also used for migraine treatment.

DHE is an old migraine treatment, but many still find it helpful. Often given in a hospital intravenously, many patients hope that an inhaled version will be a help at home.

Patients with chronic daily headache may also benefit from Levadex, assuming it gets to the market.

And it probably will. Allergan is hoping to apply for approval again before the end of the year.

via: F.D.A. Rejects New Drug for Migraines

5 February 2010

More on DHE: Home Therapy for Chronic Daily Headache?

James Discoveries & Stats, Medications 4

I appreciated Ellen’s blog post on Home therapy for intractable Migraine. She mentions an interesting study, and brings up, once again, DHE migraine treatment!

DHE, or dihydroergotamine, has been a topic of conversation here more than once. See especially DHE Migraine Treatment: Why some people still use it and Levadex â€“ inhaled migraine drug on the way. DHE has been used for migraine and cluster headache, and it remains a helpful treatment for many patients.

In her post, Ellen mentions a study in the USA reported on in Headache (from the American Headache Society) in January. The researchers wanted to find out how patients would react to a home based intravenous dihydroergotamine treatment.

This type of treatment is usually done in the hospital or clinic, which can make things a lot more difficult for many patients.

There are advantages and disadvantages to having treatment like this at home. But perhaps too often doctors default to the hospital visit, instead of considering some patients that may benefit more from home treatment.

The patients in the study saw good results. All had chronic daily headache (CDH), and in the end only one was still diagnosed with CDH. There were no serious adverse effects at all.

Though this was a very small study (only 31 patients), it may lead to more openness by doctors and specialists to new options in treatments – not only for DHE, but other treatments as well.

Thanks, Ellen!

For more, read Outpatient Home-Based Continuous Intravenous Dihydroergotamine Therapy for Intractable Migraine