DHE Treatment for Migraines

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DHE stands for dihydroergotamine. It belongs to a class of medications called ergots. Ergots work on migraines by constricting blood vessels. DHE is very effective for treating migraines. However, potentially serious side effects prevent many doctors from using it outside of controlled settings.

Intravenous

  • DHE can be administered by IV in clinics and hospitals. It works rapidly, often reducing or eliminating a headache within one hour. For complex cases, DHE may be administered every six to eight hours.

Injections

  • Doctors can prescribe DHE injections for home use. The standard dose is 1 milliliter per injection. Medical opinions differ on how often DHE injections can be used, so it is best to follow the prescribing doctor's recommendation.

Migranal

  • Migranal is a doctor-prescribed nasal spray version of DHE. One spray of the medication is given in each nostril. After 15 minutes this can be repeated. According to the manufacturer, Migranal should not be used more than twice a week.

Side Effects

  • DHE cannot be used within 24 hours of taking any triptans, which are a class of drugs used to treat migraines. Side effects include changes in heart rate or blood pressure, chest heaviness, nausea, sweating, and numbness or weakness.

Rebound Headaches

  • Rebound headaches occur when someone takes too many triptans or non-steroidal anti-inflammatory drugs in a short period of time. Doctors can use DHE to help break the headache cycle without causing further rebound headaches.

References

  • Cephalalgia; "History of the Use of Ergotamine and Dihydroergotamine in Migraine From 1906 and Onward;" PC Tfelt-Hansen and PJ Koehler; Volume 28, 2008
  • Headache; "Nasal Delivery of Antimigraine Drugs: Clinical Rationale and Evidence Base;" Alan Rapoport and Paul Winner; Volume 46, 2006
  • Diagnosis and Treatment of Headache: DHE Algorithm
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