DHE (Dihydroergotamine) and Ergotamine
Reviewed by: HU Medical Review Board | Reviewed March 2022 | Last updated: April 2023
|Use||Treat moderate-to-severe migraines when they start (acute treatment). May also be used for persistent migraine that are hard to treat or fail to respond to standard or aggressive treatment (refractory migraine). Typically a second- or third-line treatment.1-3|
|Effectiveness||Studies have shown that most ergots are not as effective in relieving migraine as triptans. They are often reserved as an option for people for whom triptans have failed or have hard-to-treat migraine.1-3|
|Side effects||Nausea, vomiting, stomach pain, leg cramps, tingling in the arms and legs1-3|
|Taken how?||Different formulations are available:|
|Drugs in this class|
Dihydroergotamine mesylate (DHE) and ergotamine tartrate (ET) belong to a class of drugs known as ergot alkaloids. They are also called ergots or ergot derivatives.1
How do ergot alkaloids treat migraine?
Ergots are some of the oldest migraine-specific drugs. They are used to treat moderate to severe migraine when they start (acute treatment). In some cases, ergots are used to treat persistent migraine that are hard to treat or fail to respond to standard or aggressive treatment (refractory migraine).2
Because ergots can cause serious side effects, they are usually a second- or third-line treatment. Ergots are often reserved as an option for people for whom triptans have failed or have hard-to-treat migraine.1-3
Ergots come in several forms, including pills, injections, suppositories, and nasal spray.1-3
How do ergot alkaloids work?
Ergots work to treat migraine similar to triptans. When certain blood vessels in the head are widened, it can cause certain types of headaches, including migraine. Ergots work by binding to certain serotonin receptors, which narrow these blood vessels. Ergots may also decrease pain and inflammatory signals in sensory nerves in the head.1
Ergots work best when taken at the first sign of a migraine attack. They will not prevent migraine or reduce the number of attacks.1
Some ergots are also combined with caffeine and other pain relievers. This helps increase their effectiveness.1
Which drugs are ergots?
Ergots include drugs that contain dihydroergotamine (DHE) or ergotamine. Examples include:4
- Cafergot® (ergotamine and caffeine) tablets
- D.H.E. 45® (dihydroergotamine mesylate) injection
- Ergomar® (ergotamine tartrate) dissolving tablets
- Migergot® (ergotamine tartrate and caffeine) suppository
- Migranal® (dihydroergotamine mesylate) nasal spray
- Trudhesa™ (dihydroergotamine mesylate) nasal spray
What are the possible side effects?
Side effects can vary depending on the specific drug you are taking. Common side effects of ergots include:1-3
- Nausea, vomiting
- Dizziness, lightheadedness
- Runny nose
- Dry mouth
- Nervousness or restlessness
Ergots may also cause serious side effects, including:1-3
- Heart problems
- Very high blood pressure
- Muscle pain or weakness in the arms or legs
- Numbness or tingling in fingers or toes
- Swelling or itching
- Stomach cramps or bloody diarrhea
- Cough with chest pain or trouble breathing
Contact your doctor right away if you have any signs or symptoms of serious side effects while taking an ergot drug.
These are not all the possible side effects of ergots. Talk to your doctor about what to expect when taking an ergot drug. You should also call your doctor if you have any changes that concern you when taking an ergot drug.
What else should you know?
Certain people should not use ergot drugs, mainly because they constrict blood vessels. You should not use ergot drugs if you:1-3
- Are allergic to ergotamine or DHE
- Have liver or kidney disease
- Have high blood pressure
- Have blood vessel problems, such as prior stroke or peripheral vascular disease
- Have coronary artery disease
- Have sepsis (life-threatening infection)
- Are pregnant or breastfeeding
- Take certain drugs that are processed by an enzyme called CYP3A4 (this can cause a life-threatening impaired blood supply)
Ergots can harm an unborn baby. If you can become pregnant, you should use birth control during treatment and for some time after the last dose of these drugs. You should also not breastfeed during treatment with ergots and for some time after the last dose. Talk to your doctor about your options for birth control and breastfeeding while taking these drugs.1,2
Ergots can interact with many other drugs. Before beginning treatment for migraine, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.1-3