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Updated: Mar 26, 2026
3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache
Published on: June 2, 2014
Exacerbation of headache during dihydroergotamine for chronic migraine does not alter outcome
Michael Eller1, Amy A Gelfand1, Nina Y Riggins1
1From the Headache Group, Department of Neurology (M.E., A.A.G., N.Y.R., C.S., P.J.G.), and Epidemiology and Biostatistics (S.S.), University of California, San Francisco; and Headache Group, Basic & Clinical Neuroscience, and NIHR-Wellcome Trust Clinical Research Facility (P.J.G.), King's College London, UK.
Objective:
To evaluate whether headache exacerbation associated with IV dihydroergotamine (DHE) infusion predicts medium-term headache outcome in patients with chronic migraine.
Methods:
This was a retrospective chart review study of the UCSF Headache Center's use of IV DHE for chronic migraine from 2008 to 2012. Medium-term headache outcome was assessed at 6-week follow-up. Univariate and multivariate logistic regression models were used to assess for predictors of outcome.
Results:
Patients with chronic migraine (n = 274) were treated with a course of IV DHE. Of 214 with 6-week follow-up, 78% had medium-term headache benefit. In a univariate logistic regression model, headache exacerbation with DHE was associated with lower odds of a positive medium-term headache outcome (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.20-0.91). However, in the multivariate logistic regression model, headache exacerbation was no longer an independent predictor of treatment outcome (OR 0.65, 95% CI 0.28-1.51). Factors that independently predicted outcome were nausea (OR 0.12, 95% CI 0.02-1.00, p = 0.05), age (OR 1.68 for each decade increase in age, 95% CI 1.24-2.28), and medication overuse (OR 0.42, 95% CI 0.18-0.97).
Conclusions:
After controlling for nausea and other factors, headache exacerbation with DHE infusions is not an independent predictor of poor headache outcome and clinicians should not interpret its presence as a reason to stop treatment. The focus of management should be on controlling nausea as it is the most important modifiable factor in achieving a good headache outcome with an inpatient course of IV DHE for chronic migraine.
Insights
Headache worsening during IV dihydroergotamine (DHE) infusion does not predict long-term outcomes for chronic migraine patients. Nausea management is key for successful treatment outcomes.
Area of Science:
- Neurology
- Clinical Pharmacology
Background:
- Chronic migraine is a debilitating neurological condition.
- Intravenous dihydroergotamine (IV DHE) is used for treating chronic migraine.
- Understanding predictors of treatment success is crucial for optimizing patient care.
Purpose of the Study:
- To determine if headache exacerbation during IV DHE infusion predicts medium-term outcomes in chronic migraine patients.
- To identify independent predictors of successful IV DHE treatment for chronic migraine.
Main Methods:
- Retrospective chart review of 274 chronic migraine patients treated with IV DHE.
- Assessment of medium-term headache outcome at 6-week follow-up.
- Univariate and multivariate logistic regression analyses to identify outcome predictors.
Main Results:
- 78% of patients achieved medium-term headache benefit.
- Headache exacerbation during DHE infusion was not an independent predictor of outcome in multivariate analysis.
- Nausea, older age, and medication overuse independently predicted poorer outcomes.
Conclusions:
- Headache exacerbation during IV DHE infusion should not deter continued treatment.
- Managing nausea is the most critical modifiable factor for achieving positive outcomes.
- This study highlights the importance of focusing on nausea control in chronic migraine management with IV DHE.
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