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Methergine for Migraine Prevention

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One of the medications your doctor may prescribe for migraine is Methergine (a brand name), otherwise known as methylergonovine maleate.  Usually used for postpartum hemorrhage (bleeding), you may wonder how this medication is used for migraine, particularly migraine prevention.

Methylergonovine maleate is known as a ergot psychedelic alkaloid.  You may be familiar with more common migraine medications with the word "ergot" in them (medications derived from the ergot fungi, as methylergonovine maleate often is), such as ergotamine (ie Cafergot) or dihydroergotamine (ie Migranal or DHE).

But these are generally used as abortives (when you have a migraine attack), whereas Methergine is usually used as a preventative.  It’s also related to another preventative – methysergide (ie Sansert and Deseril).  In fact, some doctors will use methylergonovine maleate in the place of methysergide, since it becomes methysergide in your body anyway.

Methergine influences blood flow because of the way it leads to blood vessel constriction.  It also changes serotonin use in the body (inhibiting or blocking its effects), which are known to relate to migraine (actually, this is related to the constriction).  But as with all migraine medications, there is some question about how exactly they work, and we’re relying on clinical studies to show us how well they do work.

Methylergonovine maleate is not usually tried for the length of time that most other migraine medication is given for (usually 3 months).  Your doctor will probably want to check on you after only 3 weeks or so.  Also, you will be taking breaks from the medication for 3-4 weeks after you’ve taken it for 6 months (to avoid the rare possibility of fibrosis).  Your doctor will want to supervise you closely, and she will probably want you to go off it slowly.

Occasionally, methylergonovine maleate will be given for other things besides various types of migraine.  Most notably, cluster headache.  Also, it can be given as an abortive for migraine, particularly when you have a migraine that just won’t stop.

Of course you’ll be talking to your doctor before taking this drug (a doctor who knows your medical history), but here are a few things to keep in mind.  This drug is generally not given during pregnancy.  Also, your doctor needs to know if you have hypertension (high blood pressure) or liver or kidney problems.  Be sure to tell your doctor if you experience side effects to this drug.  Finally, don’t take it with juice (especially grapefruit juice).

Methergine will be a long way from the top of the list of things your doctor will prescribe.  However, it’s also not at the bottom of the list.  If your doctor says you’ve tried everything, she’s wrong.  Please find another specialist who will keep working with you.

More information on Methergine

Deep Brain Stimulation is helping Chronic Cluster Patients

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Deep Brain Stimulation (DBS) is a treatment that is showing great promise when it comes to treating cluster.  Unfortunately, many people know very little about it.

Deep Brain Stimulation for Cluster Headache

DBS is probably most well known as a treatment for Parkinson’s disease, though it’s used for a variety of conditions, including cluster headache.

Though much of the mechanism of cluster remains a mystery, we do know that the posterior hypothalamus is involved.  The posterior hypothalamus is part of the hypothalamus part of your brain, located just above the brain stem.  Like migraine, there is likely a complex web of reactions going on that impact cluster.  However, the posterior hypothalamus seems to be a key part of the process.

So what would happen if we could stimulate this part of the brain directly?

DBS uses a battery operated device known as a neurostimulator.  This small device is surgically implanted.  It’s then able to target the posterior hypothalamus and deliver electric stimulation.

The neurostimulator itself is not in contact with the target area.  Instead, a lead/electrode wire is placed in the target area.  Then an extension connects the lead to the neurostimulator itself.  Multiple leads may be implanted in target areas.

Once the system is in place, it can be adjusted without further surgery.

Who is this treatment for?  The best candidate for deep brain stimulation is someone with chronic cluster headache.  In fact, it’s been suggested that even stricter criteria be used: patients who are the best candidates are ones who have attacks almost every day.  Also, these patients are usually not helped by the standard drug treatments.

Recently, researchers have started investigating the uses of DBS in other parts of the brain, such as the midbrain tegmentum.  We may find that some patients respond better to stimulation in one area, and others improve with stimulation in another area.

The good and the bad of deep brain stimulation for cluster…

The good news is that the surgery is generally safe.  However, that does come with a word of caution.  It’s important to have an expert team perform the surgery – if possible, someone with experience with DBS for cluster, since there are unique challenges for cluster patients.  The patient needs to be monitored to avoid problems such as bleeding and infection and issues with wire placement.  Usually these are not major problems, and treatment can be continued.  But you do need an expert who knows how to deal with them.

It’s also important to realize that improvement is not immediate.  Usually several weeks of stimulation are required before there is a real change.

The other challenge with DBS is that it’s still relatively new.  Yes, we have about 10 years of experience using it for cluster.  But chronic cluster is so rare that we’re still only talking about a few dozen patients.  More studies need to be done to understand how best to use DBS.

DBS seems to help about 60% of chronic cluster patients.  The good news is that those 60% end up almost pain-free.  And this is without drugs, which means a lower overall cost as well.

For more details on the use of DBS for cluster, read:  Deep brain stimulation in trigeminal autonomic cephalalgias. (2010 overview)  and DEEP BRAIN STIMULATION TREATMENT FOR CLUSTER HEADACHE (more in-depth overview from 2005).

Also check out Cluster or Migraine: What’s the Difference?

Peripheral Nerve Blocks and Trigger Point Injections – Research Needed

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More research is needed to investigate peripheral nerve blocks and trigger point injections for headache treatment, say researchers in the USA.

Last month the journal Headache published a review of the research on nerve blocks and trigger point injections for various types of headache, including cluster headache and migraine.

Nerve blocks and injections

The results were generally positive – there does seem to be value in these types of treatment.

That being said, this field of research is somewhat chaotic.  There is little agreement on how to go about the treatments, and the research is actually very limited.

Seeing positive results so often, it’s time to do more extensive and serious research.  This will continue to be an important field of study.

For example, this month researches in Milan, Italy published an evaluation of a treatment they’ve been using for the past five years – the sphenopalatine endoscopic ganglion block for cluster headache.  The treatment involves an injection of anesthetics and corticosteroids.

Similar treatment for cluster headache has been used in other countries even longer.  It’s a temporary relief, however it’s been a real help to many patients.  The interesting thing is that it’s successful in chronic cluster patients who were not responding to drugs.

These types of techniques are valuable because they may provide an option for others who are not responding well to drugs, but are not wanting to jump to invasive surgical procedures.

But we need more research to evaluate how to best choose treatment for individual patients.

Capsaicin – A Little Cayenne with your Migraine?

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You might have heard of capsaicin – the "active" ingredient in hot peppers – as a pain causer but also a pain reliever.  How can that be?  And, could it be useful to fight a migraine?

Capsaicin for Migraine?

Here’s the short story.  Capsaicin is a proven pain-reliever.  However, the evidence that it will specifically fight migraine is not as strong.  However, some people do feel it helps them, and it is a natural option that you might want to try.

Capsaicin creams are often used for arthritis and cluster headache.  As you might expect, it causes a slight burning feeling – particularly at first (with repeated use it gets better).  But then something surprising happens – it may actually relieve pain.  Why?

Capsaicin, it seems, has the ability to interrupt pain messages going to the brain.  The effect is not long term, but for many people it’s long enough.

Cluster headache patients sometimes apply this cream to the nostrils.  Arthritis patients put the cream over the area that hurts.  It can be used several times a day.

Strangely enough, taking capsaicin supplements (such as Nature’s Way CapsiCool Controlled Heat) or even putting cayenne or other peppers in your food may help fight migraine, indirectly.  Such supplements are believed to help with digestion, fight heart disease, fight bacteria, and act as an antioxidant.

You may have heard of the popular Sinus Buster products as well, which deliver the capsaicin in a nasal spray.  I’ve been a little biased against Sinus Buster, partly because more than once someone has spammed me trying to promote it.  Also, I have yet to see good evidence for their new product, Headache Buster, which adds feverfew and peppermint to the mix.  (Don’t get me wrong – feverfew is an excellent migraine preventative.  But the evidence is for specific formulations of feverfew taken as a supplement).

However, taking capsaicin in this form is an option, and it has helped some.  You could try the original Sinus Buster for migraine.

Capsaicin could be tried both as an abortive or preventative for migraine.  One short study on capsaicin in 2003 suggested that daily administration to the nostrils (the same as with cluster headache patients) did bring about an improvement in migraine symptoms.

If you’re thinking about using capsaicin, as always, talk to your doctor.  You may want to start with a mild cream (apply using gloves to avoid irritating the skin on your hands – and don’t get it in your eyes!  Ouch!) and then go to something stronger.  Intranasal civamide is another newer option you can ask your doctor about.

Some available options:

Read more about capsaicin at WebMD.

Cluster Headache: Seeing is one step closer to believing

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Hanging out on Twitter, I see a lot of talk about "cluster headache".  Some people actually know what they’re talking about.  But I suspect most do not.

Some seem to casually mention that they have a cluster headache today.  Some mix up terms completely, saying things like cluster migraine.  Or they say they have a migraine or a cluster headache or something.

I don’t get too upset at the people themselves, who are simply misinformed or uninformed.  But having some idea what cluster headache is (though I don’t suffer from them myself), I still get upset that the term gets thrown around so casually.

Cluster headaches are also known as "suicide headaches", and there’s a reason.  The pain is almost beyond comprehension.

I encourage you to read about the difference between migraine and cluster here.

But special thanks to A ClusterHead’s Life for posting some videos of people enduring a cluster attack.

I’ve posted one below, but I’ll warn you – it’s hard to watch.  And it’s one of the less graphic videos.  But if you want to understand cluster, take a look at a few of the videos here.  You’ll never use the word casually again.

Also posted is a lecture on cluster by Dr. Peter J. Goadsby, coauthor of many books including Mechanism and Management of Headache.

Cluster survivor from Canada:

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The articles on Headache and Migraine News are © 2004-2025 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.