Migranal (dihydroergotamine mesylate) for the treatment of migraine headaches: an introduction

Migranal, a member of the Ergotamine or ergot alkaloids class of medications, is used for treating the acute pain of migraines, but not to prevent migraines. It is also not intended for use of management of hemiplegic migraine or basilar migraine. Migranal, which came to the U.S. market in 1997, has the generic name dihydroergotamine mesylate.

How Migranal works

As with many migraine treatments, doctors and researchers are not completely certain how Migranal works. It narrows the brain’s blood vessels and also works to prevent the release of substances that lead to swelling in the brain.

Migranal effectiveness

Every medication works differently in different patients. Based on two Migranal’s studies with 200 patients each, here’s a summary of how many patients found relief from migraine symptoms with the Migranal migraine nasal spray medication compared to an inactive placebo, which is also called a dummy or sham treatment:

  • Reduction in headache pain within two hours : Migranal 47% to 61%, Placebo 23% to 33%
  • Reduction in headache pain within : Migranal 56% to 70%, Placebo 28% to 35%

Forms of Migranal available to treat migraines

Migranal is available as a nasal spray. Other medications containing the same active ingredient are available as an injection for migraines.

Most common side effects of Migranal tablets

  • Dizziness
  • Fatigue
  • Tingling or pain in the nose or throat
  • Stuffiness or dryness in the nose or nosebleeds
  • Changes in taste
  • Upset stomach
  • Vomiting
  • Weakness

Serious side effects

Some people may experience serious side effects when they take Migranal. Seek immediate medical attention immediately if you have any of the following symptoms:

  • Runny nose
  • Sneezing
  • Dryness, burning or swelling in the nose
  • Nasal obstruction or congestion
  • Taste disturbances
  • Muscle pain or weakness in arms or legs
  • Color changes, numbness or tingling in the fingers and toes
  • Chest pain
  • Changes in heart rate
  • Swelling
  • Itching
  • Faintness
  • Skin that is pale or cold
  • Difficulty speaking or slow speech
  • Dizziness

Who should not take Migranal

Do not take Migranal if you have a headache that doesn’t feel like your usual migraine, or if you have a tension headache.

People who take triptans or antifungal medications should not take Migranal.

People taking Migranal should be monitored closely for ergotism, which occurs after long-term use or overdosage of drugs in the Ergotamine class. Symptoms include vomiting, abdominal cramps and weak pulse.

Do not take Migranal if you take potent CYP 3 A4 inhibitors including HIV protease inhibitors and macrolide antibiotics, such as clarithromycin (Biaxin) which may increase the risk of insufficient blood flow to the brain (a stroke) or decreased blood supply to the extremities (the limbs).

Also don’t take Migranal if you’re already taking another drug in the Ergotamine class.

If you are pregnant, plan to become pregnant or breastfeeding, you must discuss this with your doctor before taking Migranal.

Your doctor should know if you use tobacco products, have any heart disease risk factors, diabetes, Raynaud’s disease, any condition that impacts your circulation, sepsis, heart or blood vessel surgery, heart attack, kidney, liver, lung or heart disease.

Let your doctor know if you are having surgery and your surgeon should know that you’re taking Migranal.

Do not use Migranal if you have a history or risk factors of certain heart diseases, including a low blood supply to the heart (ischemic heart disease). This includes postmenopausal women, men over age 40, high blood pressure, obesity, high cholesterol, diabetes, smoking or family history of heart disease. For those with heart disease risk factors, it is recommended that the first dose of Migranal be administered under medical supervision while heart functioning is monitoring.

Tell your doctor about all other medications and supplements you take, particularly if you take:

  • Beta blockers
  • Medications for colds and asthma
  • Oral contraceptives (birth control pills)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Tagamet (cimetidine)
  • Lotrimin (clotrimazole)
  • Neoral, Sandimmune (cyclosporine)
  • Danocrine (danazol)
  • Rescriptor (delavirdine)
  • Cardizem, Dilacor, Tiazac (diltiazem)
  • Epipen (epinephrine)
  • Diflucan (fluconazole)
  • INH, Nydrazid (isoniazid)
  • Flagyl (metronidazole)
  • Serzone (nefazodone);
  • Fortovase, Invirase (saquinavir)
  • Calan, Covera, Isoptin, Verelan (verapamil)
  • Accolate (zafirlukast)
  • Zyflo (zileuton)

Women who are pregnant, may become pregnant or who are breastfeeding should not take Migranal. Also people with hemiplegic migraine or basilar migraine shouldn’t take Migranal.



As always, the best source for advice on treating your migraines is your own migraine specialist. These medication descriptions are provided only for informational purposes. You should begin no medication regimen without first checking with your physician. Again, this information should in no way substitute or be mistaken for medical advice.

Written by: Otesa Miles | Last review date: November 2010
View References