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Dihydroergotamine Infusion

Dihydroergotamine Infusion Overview

Dihydroergotamine, or DHE, is a migraine treatment that works by stopping the release of natural substances in the brain that contribute to headache pain. It has been shown to be effective in the treatment of migraine headaches and in cluster headaches. 

DHE is a medication in a class of drugs called ergot alkaloids. DHE infusion therapy involves delivering the medication through an IV, which is done in a hospital or an infusion center. If you have never received DHE before, we prefer your first exposure to the medication to be in a hospital or an infusion center setting so that you can be closely monitored. DHE can also be injected into the muscle in a clinic setting and or taken as a nasal spray at home. DHE cannot be given as a pill.

What is dihydroergotamine infusion used for?

Dihydroergotamine infusion is a treatment for active migraine headaches. It is not used to prevent migraines. It should not be used more than three times per day. Using DHE too frequently, or within 24 hours of a triptan migraine medication, can cause constriction of blood vessels in the heart and brain and lead to a stroke or heart attack. 

DHE is used to stop a migraine and is beneficial for a migraine lasting more than a few days, which is sometimes referred to as “status migrainosus.” It can often break a headache and prevent the return of headaches for months. While DHE is not a permanent cure for migraine, symptoms will not necessarily return when the medication wears off. Regardless, other medications are utilized for prevention and acute treatment of subsequent headaches. 

Am I a good candidate for dihydroergotamine infusion?

You may be a good candidate for dihydroergotamine infusion if you suffer from debilitating migraines that do not respond to other acute treatments, especially if you have had a migraine that has lasted several days or longer.

You should not take DHE if you are talking any of the following medications:

  • Antifungals such as itraconazole (Sporanox) and ketoconazole (Nizoral)
  • HIV protease inhibitors such as indinavir (Crixivan), nelfinavir (Viracept), and ritonavir (Norvir)
  • Macrolide antibiotics such as clarithromycin (Biaxin), erythromycin (E.E.S., E-Mycin, Erythrocin), and troleandomycin (TAO)
  • Triptan migraine medications within 24 hours

You should not use DHE if you suffer from certain heart conditions. Before starting you on DHE, your migraine specialist will conduct a thorough assessment to make sure you can take the medication with minimal risk. 

Nausea is the most common side effect of DHE infusion. Your doctor may give you medication to help reduce nausea before beginning the infusion. Other common side effects of DHE include:

  • Burning at the site of infusion
  • Leg cramps
  • Vomiting
  • Chest pain
  • Warmth or pressure in the neck

It’s important that you notify your provider or nurse if any of these side effects occur during your admission. If you have side effects, we can either give medications to help with them or change the way the DHE is given.

If I am admitted for DHE, what will my hospitalization be like?

We will notify the hospital before your stay and arrange a bed for you. Once your room is ready, they will call you. You will go to the admissions area near the main entrance of St. Joseph’s Hospital and Medical Center when you arrive. The admission desk is at the front of the hospital, off of Fifth Avenue and Thomas Road. A doctor will see you once you get to your room and order the treatment. This process can take time. The typical duration of your time in the hospital for DHE is around four days, depending on the time of day you start the infusions.

Before starting the medication, you will likely get blood work collected and sent to the lab. You will also get an EKG, though this evaluation may have been done prior to your admission. You will be placed on a heart monitor so that the nurses and your physicians can monitor your heart. If you have never received DHE in the past, your first dose will be 0.5mg to make sure you tolerate it well. The second 0.5mg is generally administered half an hour later. Because DHE can cause nausea, you will receive an anti-nausea medication prior to each of your DHE doses during the admission. Throughout the admission, you will receive 1mg of DHE every eight hours until you either no longer have any headache or you reach the maximum total dose of 11mg. 

If your migraine is not responding to the DHE and your physicians feel that it is appropriate, they can provide you with other IV medications and treatments during the admission. If you still have your migraine at the end of your DHE admission, your headache specialist can discuss future options with you in the clinic during a follow-up appointment. 

Your nurses will be checking on you periodically during the day and night, and they can convey any questions or concerns you may have to your physician team.

DHE Infusion Videos

Medically Reviewed by Kerry Knievel, DO, FAHS and Shane Root, MD on September 4, 2022