Chapter 5, Episode 5: Ergot Alkaloids for Migraine Disease
This content has been medically reviewed by Andrea D. Murphy, MSN, APRN, ANP-BC, NEA-BC, AQH
Dihydroergotamine and ergotamine are two migraine treatments that have been used for decades and belong to a class of medications called ergot alkaloids. Dihydroergotamine, or DHE, is used as an acute treatment for migraine while ergotamine can be used as an acute or preventive treatment.
Ergotamine and DHE are thought to work by interacting with various receptors and chemicals in the brain to block pain signals, constrict blood vessels and decrease inflammation.¹ Ergotamine is often combined with caffeine to help improve the absorption and how quickly it starts working.
Side effects of ergot alkaloids vary based on the type of medication and how it is administered but may include nausea, vomiting, increased blood pressure, chest pain, insomnia, and more.
Ergot alkaloids are typically avoided in people who have a history of hemiplegic migraine or migraine with brainstem aura, heart or vascular disease, uncontrolled high blood pressure, sepsis, or significant liver or kidney disease.² These medications should not be used within 24 hours of taking another ergotamine medication or triptan.² They may interact with certain antifungal medications, antibiotics and anti-HIV medications.²
A provider may prescribe an ergot alkaloid with caution if a person uses
- Medications that affect the CYP3A4 liver enzyme2
- Nicotine or
- Certain antidepressants and blood pressure medications
Like many other acute medications, ergot alkaloids have the potential to cause medication overuse headache. This can occur when using these medications 10 or more days per month for more than a few months. They are not safe for people who are pregnant or breastfeeding.
However, a few benefits of using ergot alkaloids include:
- The option for the medication to be prescribed orally, intravenously, intramuscularly, subcutaneously, rectally and nasally.
- A low rate of headache recurrence and
- Relief for some people with hard to treat migraine attacks
As with all medications there are risks and benefits to using ergot alkaloids but it is important to discuss possible options with your provider to create a treatment plan that works best for you.
For more information, visit migrainedisorders.org.
Sources
- https://www.uptodate.com/contents/acute-treatment-of-migraine-in-adults#H3489319
- https://www.ncbi.nlm.nih.gov/books/NBK555953/
*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.