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Intranasal dihydroergotamine for acute migraine

Clinical bottom line:

Intranasal dihydroergotamine 2 mg has been fully tested in only one randomised trial with about 200 patients. The NNT for two hour headache response was 2.5 (1.9 to 3.7).

This information comes from an as-yet unpublished systematic review. The only outcome reported here is that of headache response at two hours, though other outcomes may be available in the full paper.


Date review completed: September 2000

Number of trials included: One randomised controlled trials

Control group: Active and placebo

Main outcomes: Headache intensity and duration

Inclusion criteria were: treatment of acute migraine with dihydroergotamine by any route; randomised allocation to treatment groups; double-blind design; adult population and headache outcomes.


Comprehensive searches of the following databases were made: MEDLINE (1966 - July 2000), EMBASE (1980 - June 2000), Cochrane Library (Issue 3, 2000) and the Oxford Pain Relief Database (1950 - 1994). A series of free text searches were undertaken, using generic and trade names. There was no restriction to language. Retrieved reports were searched for additional trials. Neither individual authors nor pharmaceutical companies were contacted for unpublished data.


Tables with all included trials and excluded trials are available.

For intranasal dihydroergotamine 2 mg, 66/105 patients (63%) had a headache response at two hours compared with 23/98 (23%) with placebo. The NNT was 2.5 (1.9 to 3.7).

Adverse effects

Adverse effects are not reported.