[Migraine: dihydroergotamine nasal spray--an alternative]

Dihydroergotamine (DHE) formerly had to be administered intramuscularly or intravenously to cope with the migraine attack. The introduction of a new regimen, the DHE nasal spray, a new era in the treatment of the migraine attack has started. The patient is independent of his physician and may avoid the painful attack by taking the treatment already during the aura. The speed and thoroughness of the relief from pain are directly proportional to the promptness with which medication is started after the onset of an attack. The recommended dose of intranasally administered DHE is 2 mg, which means two times 0.5 mg into each nostril. The effect of DHE is mediated by its affinity to the 5-HT1D-receptor. DHE furthermore reacts with other 5-HT receptors and with alpha adrenergic receptors. The side effects of DHE given by nasal route are generally mild to moderate and are primarily local ones like nose or throat problems and a bitter or abnormal taste. Nausea and vomiting rarely occur. Side effect of nasal administered DHE may not be mixed up with side effects caused by ergotamine, another ergotalkaloide with a distinct profile of effects.