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Medications & Prescription Treatment

DHE 45

  • By Teri Robert

    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 https://migraine.com/blog/living-with-migraine/help-how-can-i-not-overuse-migraine-medications/

    Teri

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  • By jdinrochester

    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.
    jackie

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    • By pwrnapper

      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.

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  • By melissadwyer13

    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.

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  • By jdinrochester

    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-
    jackie

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  • By melissadwyer13

    Yes, the torodol does nothing for my headaches, I had it in pill form and in my many ER and admissions to the hospital, they would give it to me but it did nothing to help the headache, not even take the edge off. In fact, as crazy as this sounds, when I got it IV form I swear as soon as it was pushed through IV almost instantly the pain increased sharply. It sounds insane because I know it’s a popular pain killer for migraines. I know what you mean about narcotics, as those are the only thing that will even take the edge of my migraines. I was on VERY strong IV narcotics in the hospital, which scares me, because I am so young, I have never felt as though I was addicted but the doctors all worry because of my age I could become addicted. When your in THAT much pain, OF COURSE you want the only thing that you have success in taking the edge off of your migraine, so of course I would ask for it then, but when I’m migraine free I have no interest in the stuff. Currently, at home I am also prescribed Percocet 10/325 and a steroid called Decadron, along with anti-nausea pills and suppositories when I can’t keep the pill form down to try and keep me out of the hospital. I wish for you as well that you find some relief!

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  • By Kate

    So, I am gathering from the above comments that DHE 45 isn’t so favored. I moved to TX from NC. Went to see a pain management clinic in Dallas. After 10minutes with the doctor he told me that he wanted me to do the inpatient treatment which was a week long. No comments about my current medications/preventatives etc. I went to them because I hadn’t had an appointment for 6months & my migraines are really popping through all of a sudden. Just thinking that they needed to be adjusted or changed; I am so frustrated about the whole situation. Tempted to fly back to NC

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  • By Ellen Schnakenberg

    Kate, there are no medications without a downside. Anything with the potential to help us also has the potential to harm us. The trick is finding a balance between the two extremes.

    It is possible that your pain management specialist is trying to break your cycle before addressing anything else. This can be very important. That said, a pain management specialist is rarely as well equipped as a headaches specialist to treat your Migraines. Can you get in to see one to help you soon?

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  • By wrensong

    Ok, thanks for the helpful info everyone. I just finished my first round of DHE IV therapy at the outpatient clinic over the weekend. Went in twice a day and within 12 hours of the final dose my migraine was back. And it hit like a ton of bricks. At the ER last night they gave me another round, and within about 6 hours my migraine started coming back. The Toradal takes some of the edge off. So now what? I can’t take my regular Axert becausee the DHE is in my system….I”m screwed! What have others done in this situations?

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  • By Ellen Schnakenberg

    WRENSONG –

    How are you doing today? I’m so sorry you haven’t had the result you were hoping for…. yet. I do know that this therapy can take some time to work to break a bad attack. That said, DHE can also cause rebound issues, and I can’t help but wonder if this might be what is happening to you. What is your doctor telling you at this point?

    Has your doctor discussed the use of steroids to help break your attack? What about changing your anti-nausea drug to one that may be more effective in helping abort the Migraine attack? Have they tried Benadryl? Magnesium? I’m grasping at straws hon, but you do need to know that there are options out there…

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  • By Tara

    I just want to add my experience to the thread since I think it’s important that people have feedback from patients about these treatments and not just the info we’re fed from our doctors. I had a migraine (status migraine) for 6 weeks. Was given prednisone which didn’t work, then given reglan, benadryl, dilaudid and decadron which didn’t really help either. Finally, was hospitalized for DHE treatment. I had 9 treatments total over a period of 3 days. As soon as they gave me the first dose I could tell it wasn’t going to help. It felt like all the nerves in the back of my head were tightening up. While I was in the hospital I continued to have a 6 headache. It never got better. But as soon as I was released the migraine got much much worse than it was before I was even hospitalized. I would rate it a 20 compared to what I started with. I felt that bad. I really regretted getting the treatment. I know everyone has a different experience so I am not telling anyone that this treatment isn’t right for them but it definitely didn’t help me. After that, I found a new doctor who put me on bozwellia, magnesium, coq10,fish oil, nambutone and another preventative (inderal). I’m also on 75 mg nortrypyline. I’m starting to feel a lot better. Good luck to everyone fighting these horrible migraines.

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  • By Ellen Schnakenberg

    Thank you so much for sharing your experience. While DHE can be a miracle for some patients, its unfortunate that it isn’t helpful for us all. Seeing your story will hopefully illustrate that and give patients an idea of where they might start in case it doesn’t help them. 🙂

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  • By Barbara

    I started Gabapentin shortly after this Migraine began, not as a preventative, but more as a pain reliever. I take 2-6 times daily and as of today, have obtained only minimal relief. Recently, I was also put on Verapamil as a preventative. Again, with no break in the constant pain, relief was only minimal. I have done Prednisone 2 times, and Methylprednisone high dosage once, with no relief. I have not had episodic migraines, but only one that came on suddenly and refuses to let go.

    However, working closely with my PCP and Neuro (who is the chief of Neurology in my area), we found I could obtain 2-3 hours of significant relief with the use of Migranal. Based upon this, we now started a 10 day modified Raskin protocol I can do at home. I am giving myself twice daily subcutaneous injections of DHE and taking Reglan orally 20 minutes prior to the injection.

    Relief after 2 injections is significant and I am finding that my personality is returning and I am actually smiling and participating once again. I have 18 more injections to go and a follow up appointment right after. Hope for relief is within reach and the preventatives may actually be able to do what they are intended.

    Will keep you updated.

    Barbara

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  • By Barbara

    I am on my 3rd day of DHE injections. The migraine has subsided substantially and feels something like a big ball of carbonation. The issues I am having are that my knees have become quite sore as well as some slight swelling of my hands. I have another 15 injections to go and hope that my body does not react anymore than it has already. I am feeling confident that this may in fact, break the constant pain and move it into episodic or alleviate it altogether. Wi;l keep you posted.

    Barbara

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  • By Ellen Schnakenberg

    Barbara, Hopefully this won’t become more troublesome. If it does, be sure to talk to your doctor. It’s important that we don’t make any changes to the protocols we’re given without talking to our doctors first, as stopping some medicines or adding others (including supplements) can sometimes be dangerous. Hang in there and let us know how the rest go…

    ~Ellen

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  • By Alexis Lindsay

    Does anyone else here have the IM injectable DHE treatments? My doctor has been having me use them, since nothing else has been seeming to work, and it saves me from being hospitalized quite as much. My pharmacy has recently informed me that the pharmaceutical company that was producing it has stopped production and they are now unable to special order it anymore for me. Does anyone else have this issue? My neurologist is on maternity leave and her partners seem uninterested in treating my migraines more then a prednisone pack, and I only have 6 DHE injectables left, and that will be the end of my ability to receive them. I’m hoping that maybe someone has an alternative, other then the nasal spray. Thank you.

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  • By merrie

    Hi,
    I take subcutaneous DHE-45 injections…wasn’t aware there was such a thing as IM DHE-45. My pharmacy was able to get it for me last time, but it took a while and arguing with my insurance for them to cover it. Unfortunately for me I am not having as good results as I was at first from it. Seemed to work for 1st couple of injections, now nothing?? sucks because nothing else has worked at all.

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  • By Ryan

    I think the subcutaneous vials are the same as the same as the IM except you just use a longer needle and inject it into your leg muscle. I’ve been using IM DHE since 2009. Is the only drug that keeps me going. It gives me 2 or 3 good days a week. I found this out the hard way because of the current shortage of the vials. Now all that is available is the nasal spray and that has “do not inject” all over it. The spray doesn’t work nearly as well as the IM. I’ve been tempted to just start injecting the Migrainal. Has anybody tried that yet? Does anyone know what the story is with the supply? What is a compounding pharmacy?

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    • By Kerrie Smyres Moderator

      PLEASE do not inject Migranal. The two forms have the same active ingredient, but otherwise contain different ingredients. Only DHE 45 intended for injection is safe to inject.

      One of the three companies that made DHE 45 has stopped production. Two others are still manufacturing it, but both are back ordered. One company says the issue is a manufacturing delay and the other does not provide a reason. Both companies that still make it are expecting it to be available sometime this month. This information is current as of March 31, 2014.

      Compounding pharmacies tailor medications for the needs of a particular patient. This is often done to change a medication from a pill to a liquid, remove an ingredient a patient is allergic to, or to obtain the exact dose that is unavailable in the manufactured drug. I’m not sure if they’ll be able to get dihydroergotamine mesylate, the main ingredient, but it is worth a try.

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  • By kimberlyflick

    I just finished my 3rd day of DHE treatment and now I go to an as needed status. My doctor wanted to wean me off of all my other rebound meds during this time.

    I feel like I’m going through hell.

    After 12 hours, I started vomiting and had a massive migraine. I have NEVER vomited with migraines before. I am now on the 3rd day and feel like my legs are burning from the inside out. I can’t walk without pain. When I call my doctor’s office, they tell me this is normal. Normal?! I can’t go through this every time I have a migraine! The pain is so intense I feel like pulling off my legs!

    Please tell me I’m not insane!

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  • By Kerrie Smyres Moderator

    Kimberly,

    Muscle pain is a rare but serious side effect of DHE. The drug can cause your blood vessels to constrict suddenly, which is dangerous. Muscle pain is a sign that this could be happening. (It might not be the case, but it is a serious risk that shouldn’t be ignored.)

    Most doctors tell patients to stop the drug immediately when they develop such pain. If the prescribing doctor won’t work with you on this, please contact another doctor (perhaps your primary care physician) or pharmacist to get a second opinion on what you should do.

    If the pain continues after you stop the drug and you don’t get any support from your doctor, please go to urgent care or the emergency room for testing. I don’t want to alarm you — you are very likely just fine — but you’re better to err on the side of caution.

    Here’s the information that’s usually included with the medication: http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=aec0308f-f583-4e27-9bb8-21800bde7faa. If you don’t have this already, print out that page and take it with you to any doctor you see about this.

    Again, it’s unlikely you’re in danger, but this is a potentially serious side effect that needs to be treated as such.

    Please let us know how it goes.

    Kerrie

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  • By kimberlyflick

    Kerrie,

    Thank you so much for your response. My doctor from the headache clinic called this morning and I discussed the situation with him. He still insists that the DHE is safe but that I should use 1/2 a dose. Of course, his main argument is that “no one else has those problems” or “it works for most people, I think it’ll work for you”. I told him multiple times about the severe leg pains and asked what I was supposed to do at work. He told me to take a shot while at work, I should be fine.

    He has also take me off all meds he considers rebound meds. I’m allergic to Nsaids so I can’t try those. I’m stuck with just the DHE.

    I had to leave work early today because of another headache. This is the second day in a row this has happened and, prior to DHE, I’ve only left work one other time and that was back in December. I’ve never vomited with migraines and I did on Friday, the day after I started DHE.

    I don’t know what else to say to this doctor and I’m also scared because I’ve been told not to take other meds. I don’t know what will react with DHE and what won’t. I’m just at a complete loss.

    Kimberly

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    • By Ellen Schnakenberg

      kimberlyflick,

      I’m concerned that your doc hasn’t mentioned that DHE can cause MOH (used to be known as rebound) as well as gotten serious about your side effects. NSAIDs are terrible at causing MOH as well as most anything that seems to be helpful to patients. It’s so very frustrating I know, but you’re on the right track trying to avoid MOH and treat your Migraines appropriately. It’s just so terribly tricky.

      I am a patient that can’t use DHE due to peripheral artery disease. Using it puts me in danger of gangrene and losing body parts I’m rather attached to. I got so desperate I am now talking with a vascular surgeon about a possible sympathectomy to allow me to use the medicine. Because we’re talking about my legs as well as my arms, the surgery is similar to open heart surgery, with no guarantees. Serious stuff even this skilled and experienced surgeon is nervous about performing.

      A doppler ultrasound test can be done on your legs to see if you are maintaining good circulation despite the pain. I just had mine done again a week or so ago. As my surgeon has told me repeatedly, that is no guarantee either. You may be fine today, and in trouble tomorrow. The patient needs to be smart and the doctor good at dealing with these situations. If you’re concerned, please, seek a second opinion. If there is no other headache specialist, perhaps a vascular surgeon can get you in for some advice.

      Please let us know how you’re doing, okay?

      ~Ellen

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  • By Editorial Team Keymaster

    HI Kimberly, Thanks so much for being a part of the Migraine.com community. As Kerrie stated, muscle pain is listed as a serious side effect associated with DHE – you can view the full information here: https://migraine.com/migraine-treatment/dhe-45-for-migraine-headaches/ We would strongly encourage you to revisit this issue with your physician or another physician as soon as possible to ensure you are not having a serious reaction to DHE. Please do keep us posted! Best regards, The Migraine.com Team

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  • By kimberlyflick

    I have Ultracet, Tylenol 3, Fioricet, Imitrex on prn status. The Ultracet is the one I use the most. The others are used when the migraines start and then, of course, the Imitrex for the migraine.

    I also have Tylenol with Caffeine OTC that I had started to try to use instead of Ultracet. It worked pretty well but I stand for 9 hours a day and get leg pain so I usually take the Ultracet for that, as well. I end up taking that one med probably 4-5 times a week.

    Should I get a second opinion? I’ve seen so many docs, as I know we all have, that I just want one to have that miracle cure! 🙂

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    • By Kerrie Smyres Moderator

      Kimberly,

      You’re currently on four different types of drugs that can cause rebound headaches: opioids (Ultracet and the codeine in Tylenol 3), acetaminophen (Tylenol), triptans (Imitrex) and butalbital (Fioricet). You may be best off going off one type at a time instead of all of them at once. I expect most doctors would get take you off the opioids or Fioricet first.

      It is definitely important to get you off those drugs eventually, but DHE doesn’t seem like it’s going to be a viable option. If you doctor doesn’t have any other ideas, then it is probably best to consult someone else. Here are some resources for finding a specialist: https://migraine.com/blog/looking-for-a-migraine-specialist/. If you tell me where you’re located, I might be able to give you some guidance.

      You’re in a tricky position because the drugs you’re taking are big culprits in rebound headaches and DHE and NSAIDs are the primary drugs used to get a person off rebound meds. If you’re OK with steroids, that’s probably what a doctor will try next. There are definitely treatments available to you, but it might take a bit to find the right one(s) for you.

      This has to be terribly frustrating for you. Please keep asking questions as they come up. Many of us have been through similar situations and will do our best to help you through. Hang in there.

      Kerrie

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  • By kimberlyflick

    Hi Kerrie:

    I’m in Missouri. The doc that put me on DHE is a headache specialist but I’m not sure if he’s ever experienced migraines himself.

    Personally, I think my body could have handled it better if I had gone of one med at a time. I rarely use the Fioricet, a NP gave it to me when I had to get IV treatment.

    This forum has been really helpful to me. Thank you so much.

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    • By Ellen Schnakenberg

      kimberlyflick,

      Thankfully it’s very possible to find an outstanding specialist that has never experienced a headache of any kind in their lives. There are many who have dedicated their entire lives to researching and helping those of us who do deal with them. Not all docs are created equally however.

      Here is a post that has a great handful of links to help you find someone you can hopefully trust: https://migraine.com/blog/looking-for-a-migraine-specialist/

      I also sent you a private message, so reply back if you can so we can get more specific off board.

      ~Ellen

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    • By Joy

      Kimberly, check out Dr. Bickel located in MO. I’ve heard she’s very good at what she does from friends who live there.

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  • By Monkeybrew

    DHE… This is pretty much the only abortive that is regularly effective for me. With chronic migraine, every day, this is tough because I am limited to no more than twice weekly for my DHE as an abortive. I have an arsenal of other abortives, but none are as effective.

    My reason for posting is to ask for some feedback. I am curious as to how long before folks begin to feel relief after an injection of DHE. For me it can sometimes take several hours before the migraine starts to back down. When I mention this to the nurses at my neurologist’s office they seem a bit surprised, as if it should act more quickly.

    Just curious what others’ experience is with DHE and migraine.

    MB

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    • By Barbara

      MB

      I started using DHE injections twice a day for 10 days to break the cycle of chronic daily migraine. Afterwards, it became my only abortive for use up to 4 times a week. It worked pretty well for a while although it never brought it down below a level 4. Now I have a reaction to it and can no longer use it unless it is a dire situation. My symptoms are severe neck, shoulder and back spasms as well as extreme nausea even with a double dosing of reglan.

      I can still on rare occasions use Migranal (the nasal form of DHE) but am using Gabapentin as my only preventative and abortive. I can take up to 2700mg a day of that.

      I was working at an airport near the tarmac as a baggage inspector and the fumes were my number one trigger. I had to leave that job and the longer I am away from that work environment, the better my migraine becomes. (down to a level 3 or 4 daily)

      I hope this helps and best of luck to you.

      Barbara

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  • By Katie M. Golden Moderator

    Joy,
    You can ask for anti-nausea medicine while you get your DHE infusion such as phenergan or zogran. It may help. Make sure they give it to you BEFORE the DHE.

    And I’ve had significant issues like you’re describing when I’ve gotten nerve blocks. Many times it has given me an immediate Migraine. The fact that your doctor has only performed 100 nerve blocks tells me she/he may not be that experienced. Is your doc a Headache Specialist? The neuros have special training in the 300 headache disorders that exist and focus only on treating Headache patients. If you’re looking to change doctors, consider seeing a Headache Specialist. Here is a list of docs: http://www.ucns.org/globals/axon/assets/10300.pdf

    Also you may want to consider Botox. Even if you don’t respond well to nerve blocks, you could still find Botox to be helpful. Here’s some info: https://migraine.com/migraine-treatment/botox-for-migraine/

    I wish you the best!
    =Katie

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  • By Joy

    Katie, thank you. I go to see a top neurologist who specializes in headaches. She was saying she has done hundreds not a hundred. I appreciate your concern. I just got out of a 5 days DHE infusion. I received zophran and composine at very high doses as I got sick and nauseated even with them. Since I’m only a kid they’ve done studies that Botox doesn’t work for kids but we’re going to look into it. After my 5 day infusions it was no success as my pain is back up to a 9 within a day. Luckily they at least got it down to a 6. What are some other things you guys have tried and found relief in?

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  • By Ryan

    Happy to say I’ve been able to get vials of DHE for two months running. Once in ATL and once at home in the DC metro area. Doc says all her patients have been able to get it.

    @monkeybrew – I generally get some relief within 20 minutes of injecting. Typically if I don’t get relief within 20 minutes, I’m probably not going to get much relief at all. If that happens, I might get some relief if I lay down with an icepack and use relaxation techniques. I get muscle pain when I inject, but only at the injection site and it only lasts for a few minutes.

    @MOH – My docs (Michigan Headpain, Jefferson, and Georgetown) all agree that 2 shots within 24 hours, two times per week is the max to avoid rebound. In my experience, even if I spread it out too far within the set boundaries(ie shot tues 6 pm, shot wed 4 pm, shot friday 9 am, shot saturday 5 am) I could start rebounding. To avoid this, I set a day of the week that is the “first day” (usually the most important day of the week to be functional). So if my first day is Monday and I have a headache, I’ll use the shot in the morning to try to get out the door and if it comes back or gets worse that day I’ll use the second vial allowed. However, if I get another debilitating headache on Wednesday, I might stay down for the day and save the next shot day for Thursday because sometimes I suspect the Wednesday headache of being a rebound. If the pain is super intense again on Thursday, I’d use my second shot day (risking no shots left for the weekend). Sometimes I wake up on Thursday and the headache is tolerable so I can push my second shot day to the weekend. One thing is for certain, shots become less effective the closer together I use them. So if I use my shot day Monday, and use up my second day on Tuesday, the Tuesday treatment does not reduce pain levels as effectively as if I wait until Thursday. I’ve also done infusion treatment at MHNI and Jefferson. In both cases they were trying to break a cycle with DHE. Both times I got seriously worse the next few days after treatment but after maybe five days I stabilized and got significantly better (in both instances I was able to return to work).

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  • By merrie

    Hi All,
    I just got prescribed methergine, or methylergonovine maleate, by my Dr to take three times daily for migraine prevention. The Dr said it is like Dhe that you cam take daily. (I looked it up, and this is definitely an off label use, it’s for stopping post Partum hemorrhaging.) I was wondering if anyone has used this and what your experience with it was. Also, I have been using DHE 45 for some time. I get really bad leg cramps too, but my Dr told me not to worry about it, that it was a known “normal” side effect. I will say that even the dhe is the only med I have found that helps at all, I don’t take it very often because of the leg cramps. Usually I just hide in my cave ( my bedroom).

    Joy, are you doing any better? I don’t have any magic answers. Just wanted to say I feel for you. As far as nausea with the DHE, I have found that the only way to help that for me is to take the anti nausea med at least half an hour before I take the injectable, it doesn’t work if I do them at the same time.

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    • By Joy

      Hi Katie,
      Thank you. Unfortunately I’m not doing better. After my 5 day infusions of DHE nothing has helped again. We asked my neurologist about doing DHE injections but because I’m 16 it’s not an option and I was born with a heart murmur so they have to keep me monitored while receiving DHE. With the nausea part the nurses would give me my nausea meds and wait 30 minutes before giving me DHE but we found out I’m simply very sensitive to the medicine as I would still get nauseated and throw up. I have tried the medicine you’re talking about (it’s too hard to spell it to even try right now) but for me personally it didn’t work. Now I do really think and hope it can help you because my neurologist said it works very well in adults and they haven’t learned much about it for kids. I hope it works for you. 🙂

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    • By Katie M. Golden Moderator

      Merrie,
      I was on methergine last year, but was not able to tolerate it. But everyone reacts differently to medications, so you never know unless you try. I’ve heard of it working for other people.

      The one important point I remember when I was taking it was that you need to take a “holiday” from the drug for 30 days after you’ve been using it for 6 months. Because it is originally used to stop hemorrhaging, there is a concern that scar tissue in the body can develop. Taking a break from it for a month reduces this risk. Make sure to talk to your doctor about this.

      I hope this works for you!
      -Katie

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  • By Nicole

    I am new to this site. I am being told that all manufacturers have stopped making both DHE 45 and the generic dihydroergotamine. This is the only thing that has kept me going. I have intractable migraines. I have a migraine every day. I have tried so many things it is just mind blowing. I was given DHE through Diamond Headache Clinic. Then later my neurologist that is local was able to manage with the DHE. I really need a new suggestion, if this DHE is no longer available. I have an appointment with my neurologist next week although I am not hopeful he will have any suggestions. Especially since I had to go out of state to find the DHE. Any suggestions would be greatly appreciated so I can discuss them next week.
    Thank you

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    • By Joy

      Norzech: No, I don’t believe this is true. I recently received DHE but I get it in the hospital in an IV form but they said nothing about this. Hopefully this helps.

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    • By merrie

      ((Norzech))
      I use DHE 45 and it is available now for me. One of the manufacturers stopped producing it, and there was a back log, but I was able to get it last month. Not sure about where you are though. I am in Maine. They do have to special order it for me, and the amount of vials I get per a refill has gone down, but the price was the same. Good luck to you.
      Merrie

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    • By Katie M. Golden Moderator

      Merrie,
      There is a known shortage of DHE. Valeant Pharmaceuticals North America is closing a plant in Ohio and has stopped production. Here is an article I found:

      http://www.ashp.org/menu/DrugShortages/CurrentShortages/bulletin.aspx?id=1050

      It doesn’t say when they will begin production in a new facility, but hopefully it will occur soon. I believe there are other production plants in the US, so it may be that your pharmacy just needs to find a new supplier.

      In the event you cannot get the injectable form of DHE, you may want to ask your doctor about Migranal. It’s a nasal form of DHE. It may or may not be as effective, but it’s at least a good alternative.

      -Katie

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    • By Constance Boone

      Thanks for posting about the DHE 45 production. I’ve been without it for months. I have 3 abortives I have to alternate, DHE is one of them. Now I only have two. With chronic migraines that can create a huge number of days without anything but pain meds. And my doctor and I are not agreeing right now on my pain management therapy. I’m very depressed. He gives me such a low dose and it doesn’t last. I’ve repeatedly asked for higher and/or 3 times a day instead of 2. so I end up taking more than I should when I have a “9” migraine and then run out.

      Having a hard time coping.

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    • By Katie M. Golden Moderator

      Constanc,
      You may want to try a pharmacy that is affiliated with a hospital. Most of the time, they carry just about everything and you may have better luck with them being stocked with DHE than just a CVS.

      I totally see your problem and your doctors’. You need relief. He needs to make sure you don’t get addicted or create more headaches. It’s a never ending cycle.

      Have you tried other coping mechanisms (yoga, meditation, acupuncture)? Or if you’re really unhappy with your doctor, I encourage you to get a second opinion. Especially an opinion from a Headache Specialist.

      I wish you the best!
      -Katie

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  • By smwcc2

    Hello! I realize that this is an old thread (likely due to the unavailability of injectable dhe for several years), but I’m new to injectable dhe and am hoping for some advice. So far, I’ve been injecting it sq and find that it stings horribly (at least a 10/10…way worse than the original imitrex ininjections) for maybe 20-30 seconds. I’ve been splitting into into 2 inection sites of 0.5mg/0.5mL due to the intense pain. A few hours later, each site will be red with a surrounding white (lighter than the surrounding skin) ring and raised. It’s rather tender. Over days- weeks, it slowly flattens, fades and becomes less sensitive. Is this to be expected with sq injections? Are im injections less painful? Thanks for any advice!

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    • By Katie M. Golden Moderator

      Hi smwcc2!
      I’ve actually recently recorded a video about how to administer DHE shots, but I’m not sure when it will be posted on Migraine.com. Until then, I have a few tips that might help you.

      1. It’s always hard to stick a needle into yourself. Whether you do it or get someone to do it for you, make sure the needle is completely in the flesh. If not, the liquid could bubble right under the skin. Not sure where you inject it, but I do it in my thigh and always swap legs each time because the site can be really sore for a few days.
      2. Wherever you are injecting it, the muscles need to be as relaxed as possible. Sometimes I will lay on one side so that the top thigh is resting.
      3. Also, in making sure the muscle you are injecting is completely relaxed, a nurse taught me a trick. Insert the needle and while you are pushing the DHE through the needle, take your other hand and repeatedly slap your thigh near the needle (not hard of course), but that motion almost makes the muscle relax more.
      4. Splitting the injections into 2 different sites might actually be causing you more pain. I’ve found that the quicker I push the meds through the needle, the less it hurts. Try not going slow.
      5. Once you take the needle out and put the plastic cover back on it, that’s when it usually stings the most. take your hand and rub the injection site. It will help the DHE to disperse and can quickly relieve some of the pain.
      6. If you are getting red, itchy bumps after injections, there could be two reasons. You may be slightly allergic or your skin is really sensitive. The other is that the actual DHE medication may be slightly flawed. Over the years, several times production of DHE has stopped because the manufacturer had particulate matter in the vials- these are small crystals that form and are small enough to get sucked into the syringe. You should check your supply and make sure it hasn’t been recalled. And of course mention it to your doctor- it could just be your body’s reaction.

      I really hope this helped and I’ll try to let you know when the instructional video of my DHE shots will get posted soon! These are tips I have learned through years of using DHE injections- I am not a doctor!
      -Katie, Migraine.com Team

      Hello! I realize that this is an old thread (likely due to the unavailability of injectable dhe for several years), but I’m new to injectable dhe and am hoping for some advice. So far, I’ve been injecting it sq and find that it stings horribly (at least a 10/10…way worse than the original imitrex ininjections) for maybe 20-30 seconds. I’ve been splitting into into 2 inection sites of 0.5mg/0.5mL due to the intense pain. A few hours later, each site will be red with a surrounding white (lighter than the surrounding skin) ring and raised. It’s rather tender. Over days- weeks, it slowly flattens, fades and becomes less sensitive. Is this to be expected with sq injections? Are im injections less painful? Thanks for any advice!

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  • By ladyhuckleberry

    For all that praise DHE45 you can forget me doing it: it makes me dehydrated, have worse nausea and vomiting, and other things just wishing I were dead. Besides being a dialysis patient, I have to be extremely careful of what I take and now it’s getting to the point with all of the new guidelines in place I can’t get the help I need. I don’t want any sympathy but just want to be able to deal with my headaches.

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  • By Ryan

    Anyone try buying DHE vials from Canadian mail order pharmacies? I’m paying $50 a vial WITH my insurance paying half.

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    • By pwrnapper

      Hi Ryan. YES I have purchased DHE through Canada before, quite successfully too. Just make sure you use a reputable place since too many web pharmacies are fake, sell counterfit meds or those from Asian/India companies, which have very low standards. The CIPA and Pharmacy Checker sites should help keep you out of trouble. Prices are much lower than the USA and they have not experienced the DHE shortage issues we have in the US. I’ve been using DHE for my Clusters since 2004 and have found it the best product for ME. Good luck buddy.

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  • By Michelle32

    Hello everyone,

    I am in Chelsea hospital with MHNI. They just started DHE with me after being in the hospital for almost 2 weeks (2 weeks this Tuesday) and it has really helped. My headache was a 3, almost a 4. It is now a 2, almost a 1. Mind you, I also caught the flu and viral pneumonia while here, so that set us back. I think today I will get down to a 1, and tomorrow it will be gone. I will be able to go home Tuesday, so I am excited about that. DHE has been a life saver for me. I don’t know if they will send me home with injectables or not.

    Michelle

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  • By Kerrie Smyres Moderator

    Kimberly,

    I’m concerned that your doctor is dismissing your side effect symptoms. Other people DO have these problems.

    DHE is generally safe, but it can cause life-threatening reactions in some people. Muscle pain is rare, but is a known side effect that could be indicative of severe, life-threatening complications. I don’t want to scare you, but your muscle pain isn’t something to be ignored. The FDA-approved prescribing information for DHE-45 says that patients with muscle pain should stop using the drug immediately.

    The nausea and vomiting are less worrisome (though very uncomfortable!) since they are very well-documented side effects of ergots, which DHE is. They are so common that most doctors prescribe an anti-emetic, like Reglan, Compazine or Zofran, to take along with any ergot.

    Rebound headaches are a big concern and they should definitely be addressed. In the short term, though, you may better off taking them while figuring out what drug is safe for you to try next. Even if you ultimately decide to go back on DHE or Migranal (see below), it’s better to take a break and be sure your reaction to DHE isn’t serious. A week or two or even a month or two on potential rebound-causing drugs isn’t ideal, but your safety is more important.

    If you want to work with your current doctor and stay on a DHE drug, ask about Migranal (it’s what my doctor had me try after I had to stop DHE after developing muscle pain). It is the same active ingredient in a nasal spray. It has a small amount of caffeine in it, which can cause rebound headaches, but it’s only 10 mg per dose (for reference, Excedrin Migraine has 130 mg per dose, a 12 oz Coke has 30 mg and some decaf coffee has up to 25 mg). I didn’t have muscle pain with the nasal spray, but my pain was different than what you describe. It will almost certainly cause nausea, so ask for an anti-emetic as well (I personally like dissolvable Zofran).

    What meds have you been taking and what meds do you/your doctor think are causing rebound headaches for you? There might be other non-DHE abortive meds that could give you relief and, when used judiciously, not cause rebound headaches.

    Kerrie

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  • By Joy

    Ok guys, I’m 16 and I’ve had a constant migraine for 13 months. I’ve done acupuncture, medications, nerve blocks, DHE, etc. I met with my neurologist yesterday who scheduled me outpatient for DHE 2 times a day from 8 am – 5 am in the hospital. It makes me SOO nauseous do you have any tips for it?? If I can help the nausea with the IV DHE it would be so much easier. Do you have any tips on what other treatments I can try?? I’m pretty much completely done with my neurologist. When I got my nerve blocks they were painful so I cried and she said that nobody has had that reaction and has cried and she’s done over 100. She even added that she did one on someone earlier in the day who talked to her while she was getting them. Everyone is different though!! Also she had me stand on one leg with my eyes closed on the side of my migraine and I fell over so she’s having me start physical therapy. I used to be a level 9 gymnast so it was very odd to fall over like that.

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