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Office-based treatment of acute migraine with dihydroergotamine mesylate
P Winner1, D Dalessio, N Mathew
1Palm Beach Headache Center, Florida 33407.
Abstract:
The Regional Migraine Field Trial assessed the efficacy and safety of dihydroergotamine mesylate (D.H.E. 45) for migraine in the office setting. Patients were admitted to the study provided they met the International Headache Society definition of migraine with or without aura. Thirty-eight neurologists enrolled 311 patients (274 women and 37 men) between the ages of 13 and 70 years in this open-design study. Ninety-five percent of the patients had moderate or severe headache pain at entry, and 62% had nausea. All patients received a single intramuscular injection of D.H.E. 45 1 mg. A second intramuscular injection of 1 mg was given 60 minutes after the first injection, if needed. An antiemetic was administered concomitantly with D.H.E. 45, if needed. Rescue therapy was given at the investigators' discretion. Efficacy was judged by the relief of pain, patients' ability to function, need for a second injection, need for rescue medication, and need for an antiemetic. At 30 and 60 minutes, 46% and 72% of patients had only mild or no head pain, respectively. At 24 hours, 77% of all patients had mild or no head pain. D.H.E. 45 also improved functional ability. At 30 and 60 minutes, 58% and 75% of patients had only mild or no disability, respectively. At 24 hours, 81% had mild or no impairment. Nausea was present in 62% of patients at the outset, 40% of patients at 30 minutes, and 30% at 60 minutes. An antiemetic was given to 43% of patients at the outset. The presence of nausea was similar whether or not patients received an antiemetic.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Dihydroergotamine mesylate (D.H.E. 45) effectively treated migraine pain and improved function in an office setting. This study shows D.H.E. 45 is a safe and effective migraine therapy.
Area of Science:
- Neurology
- Pharmacology
Background:
- Migraine is a debilitating neurological condition affecting millions worldwide.
- Current treatments for acute migraine attacks vary in efficacy and patient tolerance.
Purpose of the Study:
- To assess the efficacy and safety of dihydroergotamine mesylate (D.H.E. 45) for migraine treatment in an office setting.
- To evaluate D.H.E. 45's impact on pain relief, functional ability, and associated symptoms like nausea.
Main Methods:
- An open-design, multi-center trial involving 311 patients meeting International Headache Society migraine criteria.
- Patients received one or two intramuscular injections of D.H.E. 45 (1 mg each).
- Efficacy was measured by pain relief, functional improvement, and need for rescue medication or antiemetics.
Main Results:
- Significant pain reduction was observed, with 72% experiencing mild or no head pain at 60 minutes and 77% at 24 hours.
- Functional ability improved substantially, with 75% reporting mild or no disability at 60 minutes and 81% at 24 hours.
- Nausea decreased from 62% at baseline to 30% at 60 minutes, regardless of antiemetic use.
Conclusions:
- Dihydroergotamine mesylate (D.H.E. 45) is an effective treatment for acute migraine attacks in an office setting.
- D.H.E. 45 provides rapid pain relief and functional improvement with manageable side effects.
- The study supports the use of D.H.E. 45 as a valuable therapeutic option for migraine patients.