dihydroergotamine

17 April 2013

Levadex – Rejected Again

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

19 September 2009

My Hair Hurts! Migraine and Allodynia

James Information, Medications 28

Like about 2/3 of migraineurs, allodynia is one of the wonderful symptoms that comes along with many of my migraine attacks. It’s always uncomfortable, and usually painful, and believe it or not most people have never heard of it.

Allodynia. Migraineurs often suffer from cutaneous allodynia – that is, sensitivity and/or pain when the skin is touched. Most common in women, it often comes during the headache stage of a migraine attack (if there is a headache at all), but for many people it comes before, and is a kind of "warning signal". The skin becomes so sensitive, that it may feel like your "hair hurts". Running a comb through your hair can be excruciating.

Though allodynia on the scalp is the most commonly known, some people (like me) get sensitivity on other parts of the skin – such as the arms. If you wear jewelry, it might become impossible during an attack. Just wearing a shirt can cause a great deal of pain – that’s right, just the brushing of a sleeve against your skin. Standing near a stove, even standing in the wind, can be a real problem.

Muscle tenderness could also be a related symptom, especially in the head and neck.

Studies are showing us how allodynia fits into a migraine attack. It’s believed that the hypersensitivity is a part of the migraine chain reaction, where neurons become sensitized. A vicious cycle of hypersensitivity and pain is a main feature of the migraine reaction in the brain.

Though for some the symptom is brief and not worth comparing to other symptoms (like headache or nausea), for others it can be very debilitating. It also may be that people with allodynia are at risk for worsening migraine – where you start having attacks more and more often. So what about treatment?

Treating Migraine with Allodynia

We’re still waiting for research on many of the new medications that are being used for migraine. It’s been suggested that one of the older (and now less frequently used) medications, may help with allodynia in some patients. That is dihydroergotamine (DHE).

Another class of drugs that might help is a cyclooxygenase inhibitor, a type of anti-inflammatory drug. There have been concerns about Cox2 inhibitors and their link to heart problems. However, if your symptoms are severe you may want to give one a try after talking to your doctor.

Some studies have suggested that triptan drugs (like Imitrex) don’t work well in the presence of allodynia. Today, this is being questioned.

Probably your best bet is to treat migraine as a whole, and if you’re taking abortive medication take it as soon as you feel the migraine attack starting. Generally speaking, if you find a treatment that fights your migraine attacks, you should also find your allodynia decreasing.

There is one thing that can make allodynia worse – and that is opioid drugs, such as codeine and meperidine (Demerol). In most cases these are better avoided in migraine treatment, but allodynia may give you another reason to look for other options.

Allodynia and Migraine – Summary

Pain on your skin, especially the scalp and arms, is very common in migraine. It’s not your imagination! It’s actually an important feature of migraine that is teaching us more about what happens in the brain during an attack.

As you treat your migraine disease, pay attention to increasing or decreasing allodynia, and discuss it with your doctor. You may be able to find better treatment options, using allodynia as another clue.

20 February 2009

DHE Migraine Treatment: Why some people still use it

James Medications 125

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.