Office-Based Treatment of Acute Migraine With Dihydroergotamine Mesylate |
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Authors: | Paul Winner D.O. Donald Dalessio M.D. Ninan Mathew M.D. Carl Sadowsky M.D. L. Jay Turkewitz M.D. Frederick Sheftell M.D. Stephen D. Silberstein M.D. Seymour Solomon M.D. |
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Affiliation: | Palm Beach Headache Center, Palm Beach, Florida; Scripps Clinic, La Jolla, California; Houston Headache Clinic, Houston, Texas; Midwest Center for Head Pain Management, Dayton, Ohio; New England Center for Headache, Stamford, Connecticut; Comprehensive Headache Center, Germantown Hospital, Philadelphia, Pennsylvania; Montefiore Medical Center, Albert Einstein College of Medicine |
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Abstract: | SYNOPSIS The Regional Migraine Field Trial assessed the efficacy and safety of dihydroergotamine mesylate (D.H.E. 45 (r) ) 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 (r) 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 (r) , 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 (r) 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. Rescue medication was needed for 11% of patients, and adverse events were reported by 9%. In conclusion, D.H.E. 45 (r) is effective therapy for acute migraine. A second dose provides additional relief, if needed. |
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Keywords: | office-based migraine dihydroergotamine mesylate |
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