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DHE 45

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  1. Yes. DHE needs to be limited to no more than two or three days a week to avoid rebound headaches, aka medication overuse headache (MOH). Also, contrary to what was previously thought, alternating medications will not keep us from getting into MOH. We need to limit the total days a week that we treat with abortives or pain meds to no more than two or three days a week. This might help -- Help! How Can I Not Overuse Migraine Medications? at


    1. Hi! I am migraine w/o aura intractable migraine (new diagnosis on the doc's sheet)....anyhow, I use DHE45 and I also inject Toradol IM. My neuro believes out of all the meds out there dhe45 is the one of the least meds that will give you rebound but yes to only use it 2/3 times week. Sometimes when I am having a migraine that just will not stop, over 48-72 hours or more, he will tell me to use the DHE45 Protocol. That's DHE45 every 8hours (3xday)for 5 days straight. I would never do that on my own, only under doctor's orders. Alot of doctors might put you in the hospital for that and do it with IV meds.


      1. For us Cluster sufferers out there, including me for over 12 years, when we have 5-6 attacks per DAY trying to limit DHE to only 2-3 days per week doesn't help. What I have been able to do is cut the recommended dosage down to 0.25-0.35 ml per injection, which is enough to tame the beast for ME and still remain under the FDA guideline limits per day and weekly. This is the good thing about injection is we have the ability to vary the dose and make adjustments that work for us. This is certainly an individual thing and the amount of DHE will vary depending on YOUR needs. But for those is multiple daily Clusters or migraines this may work for you like it does for me. Of course I also use O2 with a non-breather mask during those attacks IF I am at home. A cold neck pillow also helps.

    2. During one of my many hospital inpatient stays, my doctor tried the DHE treatment... hoping to break it as I was in and out of the ER several times a week and admitted half of those times for a week at a time. He used DHE 9 doses the first time, tried some other things with it including keeping my vomitting and nausea under control (which is one of my biggest problems with my daily chronic migraines-- I get sick over and over. I was discharged and it was unsuccessful. When I was back in the ER and admitted a few days later he gave me two more rounds of 9 doses each. I got a total of 27 doses very, very close together. He said that was the highest dose and amount of DHE he had ever seen in his many years of practicing neurology. I never did respond to it and they decided it was best to not keep going through that.

      1. I was also hospitalized for a week 11/17/09-11/24/09 by a consulting neurologist(she's on the board of AHS) who normally does the dhe45 by IV plus the anti-nausea to stop a bad round of migraines. Well at the time I was taking dhe45 everyday and she felt I was in rebound from that. So, she gave me a script of percocet 10/325 until a room opened up on the neurology wing. Went thru that pretty quick!! My treatment in the hospital was IV Toradol every 6hrs along with 50mg Thorazine and 75mg Benadryl plus all my regular meds. Her goal was to keep me there until I had no headache whatsoever. Never happened. By the 24th, we talked about Lidocaine drip which is done down in Pittsburgh at the clinic down there but our hospital's neuro wing wasn't set up for it and I'd have to go to ICU. We decided that would be a little too much and I was anxious to get home; Thanksgiving and all. So, she upped my Topamax and gave me instructions to keep upping it and also gave me a script for the Toradol in a pill, which my neuro turned over into an injectable form because you can only have so much of that per month because you'll kill your kidneys and it ain't no miracle drug, just might take the edge off a touch. I never go thru my 10 vials. As of last year I am on SSD because of these chronic migraine/intractable migraine they are a biatch aren't they? I had gotten to the point of not being able to work without taking narcotics! Now isn't that silly? I have no narcotics now and I'm going into a pain management program. I'm anxious to see how that works out.

        Good luck to you-


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