[Ergotism in migraine. Peripheral vascular complications in 14 patients with migraine]

The general occurrence of subclinical ergotism with reduced peripheral systolic blood pressures in patients taking ergotaminepreparations regularly for migraine and the frequent occurrence of milder symptoms indicates that severe ischaemia of the extremities is not as rare a complication as would appear from the few case reports published. The 14 cases reported here constitute the largest series published of migraine patients with acute ergotism. The patients, all women, were admitted to a vascular department over a period of 14 years. They suffered from severe ischaemia of one or more extremities after consumption of varying doses of ergotamine tartrate. Ten patients had previously exhibited symptoms of acute or chronic ergotism, but only eight were admitted with this diagnosis. Liver enzyme tests were abnormal in five out of six patients examined, while three patients had ECG signs of myocardial ischaemia, regressing during treatment. At the beginning of the period, hyperbaric oxygen at 3 ATAB was the standard treatment. Since 1980, the treatment of choice has been continous i.v. nitroglycerine infusion for 24 hours. Nine patients experienced prolonged postischaemic symptoms; one patient required a forefoot amputation and four patients had permanent ischaemic muscular damage. Increased bioavailability of ergotamine due to hepatic vasospasm is suggested as a cause of sudden reduced tolerance to ergotamine. Peripheral systolic pressures and liver function tests should be controlled in patients taking ergotamine regularly. Subclinical ergotism over a prolonged period may facilitate development of occlusive peripheral vascular disease.