Ergotamines for Cluster Headaches

Examples

Generic NameBrand Name
dihydroergotamine Migranal
ergotamineErgomar
ergotamine with caffeineCafergot, Migergot

Dihydroergotamine can also be given through a vein (intravenous, or IV) or by an injection in the muscle (intramuscular, or IM) for emergency treatment of a severe cluster headache.

How It Works

Ergotamine narrows blood vessels in the head (vasoconstriction), which relieves pain by reducing pressure on pain-sensitive structures in the head and scalp that may be associated with cluster headaches. This drug may also affect certain brain chemicals that affect how a person feels pain.

Why It Is Used

Dihydroergotamine and ergotamine are used to stop a cluster headache. Ergotamine may also be used to prevent cluster headaches during a cluster cycle.

How Well It Works

When taken at bedtime or several hours before going to sleep, ergotamine is especially useful for preventing headaches at night.1

The nasal spray form of dihydroergotamine can help reduce the pain of a cluster headache when used at the first sign you are getting one.2

Dihydroergotamine, which is typically given as a shot, may provide rapid relief of a headache. A person may be able to give his or her own shot.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor right away if you have:

  • Hives.
  • Signs of an overdose, such as:
    • Dizziness, weakness, or extreme drowsiness.
    • Seizures.
    • Severe nausea, vomiting, stomach pain, or diarrhea.
  • Signs of a problem with blood circulation, such as:
    • Chest pain.
    • Confusion.
    • Fast or slow heartbeat.
    • Muscle pain or pain in the legs or arms.
    • Pale or blue-colored hands or feet.
    • Vision changes.

Check with your doctor if you have:

  • Itching.
  • Tingling or weakness in fingers or toes.
  • Swelling in the feet, lower legs, or fingers.

Common side effects of this medicine include:

  • Burning, tingling, dryness or pain in the nose (nasal spray).
  • Change in the sense of taste (nasal spray).
  • Diarrhea.
  • Nausea.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

To treat a cluster headache that has already begun, ergotamine must be used as early as possible for best results. The sooner you treat the headache, the less painful it may be.

If you are taking ergotamine, be sure to follow your doctor's instructions on when and how often to take it. Overuse of ergotamine can lead to a rebound headache.

Ergotamine should not be used with serotonin receptor agonists (triptans), such as naratriptan, rizatriptan, sumatriptan, or zolmitriptan.

Ergotamine should not be used to treat headaches in children. And it should not be used in women who are pregnant or who are thinking about becoming pregnant.

Also, ergotamine should not be used by people who have:

  • A fever.
  • Uncontrolled high blood pressure (hypertension).
  • Cerebrovascular, cardiovascular, or peripheral arterial diseases.
  • Coronary or ischemic heart disease.
  • Liver (hepatic) or kidney (renal) diseases.
  • Enlarged prostate.
  • Bowel obstruction.
  • Recent surgery.
  • Glaucoma.
  • A history of irregular heartbeat (arrhythmia).
  • Problems with circulation.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

Do not use this medicine if you are pregnant, breast-feeding, or planning to get pregnant. If you need to use this medicine, talk to your doctor about how you can prevent pregnancy.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

Citations

  1. Ropper AH, Samuels MA (2009). Cluster headache section of Headache and other craniofacial pains. In Adams and Victor's Principles of Neurology, 9th ed., pp. 174–176. New York: McGraw-Hill.
  2. Capobianco DJ, Dodick DW (2006). Diagnosis and treatment of cluster headache. Seminars in Neurology, 26(2): 242–259.

Credits

By Healthwise Staff
Anne C. Poinier, MD - Internal Medicine
Colin Chalk, MD, CM, FRCPC - Neurology
Last Revised May 14, 2012

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