Dihydroergotamine and its use in migraine with posterior fossa symptoms

Dihydroergotamine (DHE) has been used for decades to treat migraine, but is currently contraindicated in patients with hemiplegic migraine and basilar-type migraine (BTM).

To assess the safety of DHE in patients with symptoms of BTM that do not meet criteria for BTM.

Retrospective analysis of patients admitted to an outpatient infusion room at a tertiary care center caring for patients with headache disorders. Incidence and types of adverse events as well as pain levels were reviewed and analyzed. Pain was assessed via the visual analog scale (VAS).

Fifty consecutive patient records were reviewed. Mean age was 38.42. All patients met International Classification of Headache Disorders-II (ICHD-II) criteria for migraine and reported 1 posterior fossa symptom as defined by the ICHD-II criteria for BTM. Patients did not necessarily have a posterior fossa symptom in the attack treated. Eighteen percent (9/50) patients had adverse events, and only 3 of these halted DHE infusion. No patients had neurologic or cardiologic events. The mean decrease in pain was 3 points on the VAS (P <.0001). Sixty-two percent of patients achieved complete relief of headache with co-administration of DHE and other medications.

Dihydroergotamine showed no serious adverse events in patients with 1 posterior fossa symptom and migraine. Larger, adequately powered, controlled, prospective trials are indicated to assess safety of DHE in BTM.