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Ergotamine for migraine

Ergotamine and dihydroergotamine have been used for migraine for many years. A consensus panel of the American Academy of Neurology has reviewed the evidence and produced guidance [1].

The review consisted of a Medline search for the years to 1991, together with examining references in textbooks. All types of study architecture were allowed, and details are given of 156 articles. Few were randomised trials, and many of these were difficult to interpret because they antedated IHS classification of headache, few compared ergotamine with placebo, there were no uniform definitions of outcome or improvement and adverse events were either not mentioned or not emphasised.

The panel came up with the following:

Standards

The use of ergotamine tartrate in the treatment of migraine in adults may be recommended as safe and effective when used in recommended doses and when patients in whom there are contraindications are excluded.

The use of dihydroergotamine in the treatment of migraine in adults may be recommended as safe and effective when used in recommended doses and when patients in whom there are contraindications are excluded.

Contraindications include renal or hepatic failure, pregnancy, coronary, cerebral and peripheral vascular disease, hypertension and sepsis.

Guidelines

Repetitive intravenous digydroergotamine, given over 3 to 7 days in an inpatient setting, is effective and safe in the treatment of intractable headache in adults.

The use of ergotamine tartrate should be restricted to no more than 2 usage days per week (except at or around a menstrual period provided that limited or no use occurs during the remainder of the month. The total weekly dose should not exceed 10 mg.

Reference:

SD Silberstein, WB Young et al. Safety and efficacy of ergotamine tartrate and digydroergotamine in the treatment of migraine and status migrainosus. Neurology 1995 45: 577-584.