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Ergotamine and dihydroergotamine: a review
Marcelo E Bigal1, Stewart J Tepper
1The New England Center for Headache, 778 Long Ridge Road, Stamford, CT 06902, USA. mbigal@aecom.yu.edu
Current Pain and Headache Reports
|January 15, 2003
Summary
Ergot alkaloids, once primary migraine treatments, are less common due to triptans. While oral ergotamine is less effective than sumatriptan, rectal formulations show promise for severe migraine attacks.
Area of Science:
- Neurology
- Pharmacology
Background:
- Ergot alkaloids represent the earliest specific antimigraine therapies.
- Their clinical utility has diminished following the introduction of triptans, necessitating a re-evaluation of their role.
Purpose of the Study:
- To review the pharmacology, efficacy, and safety of ergot alkaloids in migraine treatment.
- To compare the effectiveness of ergotamine formulations against placebo and triptans.
Main Methods:
- Review of randomized clinical trials comparing ergotamine (oral, rectal, intranasal) with placebo and sumatriptan.
- Analysis of efficacy data based on headache relief percentages.
Main Results:
- Oral ergotamine demonstrated superiority over placebo but was inferior to oral sumatriptan.
- Rectal ergotamine exhibited higher efficacy (73% headache relief) compared to rectal sumatriptan (63%).
- Intranasal dihydroergotamine was effective but less so than subcutaneous and intranasal sumatriptan.
Conclusions:
- Ergotamine remains a viable option for severe migraine attacks, particularly in specific formulations and patient groups like those with status migrainous or frequent recurrence.
- Despite the availability of safer and more effective triptans, ergotamine can be considered safe and useful when used appropriately.
- Rectal ergotamine shows competitive efficacy, suggesting a continued, albeit refined, role in migraine management.