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Dihydroergotamine

9 10 Dihydroergotamine


Presentation

  • Abdominal migraines present with debilitating symptoms in adolescence. At our institution, the gastroenterology, neurology, and autonomic departments collaborated in treating patients with such presentations.[ncbi.nlm.nih.gov]
  • The aim of the present study was to investigate whether antimigraine ergot compounds may act at endothelial 5-hydroxytryptamine (5-HT) receptors which trigger the release of endothelium-derived relaxing factor (EDRF).[ncbi.nlm.nih.gov]
  • The results of tests performed on the autonomic nervous system are recorded, and the evidence for a central defect in postural blood pressure control is presented.[ncbi.nlm.nih.gov]
  • We present three cases of the use of dihydroergotamine and metoclopramide in patients with organic headache (two patients with viral meningitis and one patient with meningeal carcinomatosis). All three patients had excellent symptomatic relief.[ncbi.nlm.nih.gov]
  • The safety and efficacy data presented here are derived from clinical trials and case series involving DHE administered by intravenous infusion, intramuscular or subcutaneous injection, or intranasal spray.[ncbi.nlm.nih.gov]
Splenomegaly
  • We describe the case of a 42 year old woman with abdominal pain, ascites, and splenomegaly after having taken dihydroergotamine continuously for three months due to frequent hemicranic episodes.[ncbi.nlm.nih.gov]
Intravenous Administration
  • INTRODUCTION: Dihydroergotamine mesylate (DHE) has been used as an acute migraine treatment since 1945, although tolerability with intravenous administration has limited its use.[ncbi.nlm.nih.gov]
  • Intravenous administration provides rapid peak plasma levels and is the most effective form when a rapid effect is desired or for patients with intractable severe headache (status migrainosus, transformed migraine, rebound headache) and cluster headache[ncbi.nlm.nih.gov]
  • Cerebral blood flow (after intravenous administration of 133Xe) and arteriojugular venous difference of oxygen (AVDO2) were measured before, and 30 minutes after, dihydroergotamine/placebo administration.[ncbi.nlm.nih.gov]
  • Intravenous administration is considered to be the best way to treat chronic daily headache and status post migranosus, inpatient or outpatient.[chicagoheadacheclinic.com]
  • Dihydroergotamine mesylate has been used as an acute migraine treatment since 1945, but tolerability of intravenous administration limited its use. Ergotism can result from prolonged, excessive use.[medlink.com]
Chest Pain
  • Brief episodes of chest pain persisted for several days and resolved spontaneously before the woman's discharge.[ncbi.nlm.nih.gov]
  • As regards side effects and safety, the treatment triggered chest pain suspected of being vasospastic angina in 1 patient on day 7 of the treatment, when she was in the subcutaneous phase.[ncbi.nlm.nih.gov]
  • They need to know if you have any of these conditions: blood vessel problems, or surgery on your arteries chest pain heart disease high blood pressure infection kidney disease liver disease risk factors for heart disease like smoking, high cholesterol[healthlibrary.brighamandwomens.org]
  • pain and trouble breathing; or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety , confusion, chest pain, shortness of breath).[drugs.com]
  • You should not use dihydroergotamine nasal if you have a history of heart disease, angina (chest pain), blood circulation problems, heart attack or stroke, or if you have coronary artery disease, uncontrolled high blood pressure, severe liver or kidney[mottchildren.org]
Acroparesthesia
  • Adverse effects associated with ET (which are often due to excessive dosage and/or chronic usage) include nausea, acroparesthesia, ischemia, habituation and overuse headache, and, rarely, overt ergotism.[ncbi.nlm.nih.gov]
Babinski Sign
  • Neurologic examination showed left arm weakness and sensory loss, blurring of the left optic disc, and bilateral Babinski signs.[ncbi.nlm.nih.gov]

Workup

  • Prescribing information for dihydroergotamine cautions against its use in patients with coronary artery disease or risk factors for underlying coronary artery disease without a cardiac workup before initiation of therapy.[ncbi.nlm.nih.gov]

Treatment

  • As regards side effects and safety, the treatment triggered chest pain suspected of being vasospastic angina in 1 patient on day 7 of the treatment, when she was in the subcutaneous phase.[ncbi.nlm.nih.gov]
  • Patients who failed previous treatments with one or more triptan formulations were considered refractory to triptan treatment and were included in the study.[ncbi.nlm.nih.gov]
  • RESULTS: Treatment with MAP0004 was significantly more effective than placebo in relieving pain at all treatment points ( 1 hour after start of migraine: 66% [74/112] for MAP0004 vs 41% [48/118] for placebo, P 1 to 4 hours: 60% [91/153] vs 35% [58/168[ncbi.nlm.nih.gov]
  • 4 hours after treatment.[ncbi.nlm.nih.gov]
  • Abstract Recently, a new nasal spray formulation of dihydroergotamine was developed which facilitates at-home treatment of migraine.[ncbi.nlm.nih.gov]

Pathophysiology

  • […] unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and with short-lasting unilateral neuralgiform headache attacks with autonomic symptoms (SUNA) remains challenging in view of the limited understanding of their pathophysiological[ncbi.nlm.nih.gov]
  • Doodipala Samba Reddy , The pathophysiological and pharmacological basis of current drug treatment of migraine headache , Expert Review of Clinical Pharmacology , 10.1586/ecp.13.14 , 6 , 3 , (271-288) , (2014) .[doi.org]
  • Doodipala Samba Reddy, The pathophysiological and pharmacological basis of current drug treatment of migraine headache, Expert Review of Clinical Pharmacology, 10.1586/ecp.13.14, 6, 3, (271-288), (2014).[doi.org]

Prevention

  • The findings of the PROMISE study also suggest that patients' quality of life should be assessed systematically before initiating a preventive treatment for migraine.[ncbi.nlm.nih.gov]
  • Tilt table testing over a two-month period confirmed the beneficial effect of the medication in preventing profound falls of blood pressure. The dose required (20 mg/day) was higher than previously reported.[ncbi.nlm.nih.gov]
  • There have been several reports of vasospasm and peripheral gangrene caused by DHE used in combination with heparin for prevention of deep venous thrombosis. Clinical experience with the use of DHE in head trauma is limited.[ncbi.nlm.nih.gov]
  • The venoconstrictive agent dihydroergotamine (DHE) had little effect in preventing a fall in forearm venous tone with head up tilting but caused a recumbent pressor response leading to side effects.[ncbi.nlm.nih.gov]
  • Effectiveness of the oral formulation in migraine prevention is not substantiated by clinical trials. The adverse effect profile is very favorable compared to other ergot alkaloids.[ncbi.nlm.nih.gov]

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