Dihydroergotamine (DHE) for Migraine Treatment

Learn more about dihydroergotamine, a migraine-specific acute treatment

People living with migraine have many options when it comes to acute or rescue treatments of migraine. Acute treatment focuses on relieving migraine attacks when they occur, while preventive treatment focuses on lowering the number of attacks in the future. Dihydroergotamine (DHE) is a migraine-specific acute medication that can help relieve migraine attacks.

Forms of dihydroergotamine

DHE is a good migraine treatment option because it comes in many different forms, including nasal sprays, injection and intravenous infusion (delivered directly into the vein). Doctors typically do not offer it in oral form because it’s poorly absorbed through the gut, so it can be a good alternative for people who cannot swallow pills.

DHE Nasal Spray

DHE nasal sprays are quick-acting, and patients can give it to themselves. It’s important to spray it into the nostril while your head is upright to make sure the medication enters the bloodstream through tissues in the nose. Nasal sprays are useful if you often experience nausea and vomiting during a migraine attack and find it hard to swallow or keep down pills. The effectiveness of DHE nasal sprays can differ because it is based on how fast your body absorbs the medication.

DHE by Injection

Injecting DHE is effective and consistent because nearly 100% of the medication gets into the bloodstream. DHE can be injected into the muscle or under the skin, and patients can be taught to inject themselves. An injection is a useful option for those looking for effective, fast relief.  The main possible side effects are nausea, injection site reactions (swelling or redness)  and pain associated with the injection itself.

DHE Intravenous Infusion

Getting DHE intravenously (IV) is the fastest, most effective method, but it requires a medical professional to administer the medication. IV DHE is typically given through several injections in the emergency room or an infusion center. Doctors also use it in inpatient settings for treating status migrainosus, or a migraine that lasts more than 72 hours.

Benefits of dihydroergotamine

DHE is a fast-acting, effective way to treat a migraine attack and has a couple of benefits over other forms of treatment. For example, DHE has low rates of a migraine attack returning within 24 hours after relief from the initial attack. It also has a lower risk of medication overuse headache, making it a good option for patients with very frequent migraine attacks.

As with all acute treatments, it’s important to take the medication as soon as a migraine attack starts, but DHE can still be sometimes an effective treatment even if taken later into an attack.

Who can take dihydroergotamine?

Researchers who conducted a review of DHE write that this treatment is often effective in patients who wake up with a migraine attack (nearly half of people with migraine), have menstrual migraine, have allodynia (experiencing pain from things that aren’t normally painful, like brushing your hair) or severe and/or prolonged migraine, like status migrainosus. It’s also a good option for patients who do not respond to triptans, or have stopped responding to triptans.

DHE has FDA approval for the acute treatment of cluster headache. But there is limited evidence to support its use for cluster headache.

Although DHE is an effective medication for migraine treatment, it does have several limitations. Patients cannot use it during pregnancy. In addition, patients with a history or suspicion of heart disease, including coronary artery vasospasm or Prinzmetal’s angina, severe peripheral vascular disease and uncontrolled high blood pressure should not take DHE. DHE does not work for hemiplegic migraine. Finally, patients should not use DHE within 24 hours of taking a triptan medication.

DHE tends to be a later choice for migraine treatment, after patients try other options such as NSAIDs and triptans. However, knowing about DHE, its various forms and its benefits can help you start the conversation with your healthcare professional.

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.