Dihydroergotamine (DHE) provides clinically effective outcomes for patients with migraine attacks not responsive to triptans, who have a larger burden from migraine, and in refractory migraine, described in a study published in Dovepress.

DHE is an ergot alkaloid which was first used in the field of obstetrics and gynecology, and later used for the treatment of migraine. Being compared to its derivative, ergotamine, it portrayed superior alpha-adrenergic antagonist activity, lesser arterial vasoconstriction, reduced dopaminergic agonism, and lower emetic potential. The preferred routes of administration are intravenous (IV), intramuscular (IM), subcutaneous (SC), intranasal (IN) and oral. It can be used in an outpatient basis in infusion centers, EDs, and urgent care centers, in addition to inpatient treatment for admitted patients. There are various protocols for using DHE in adults and pediatric treatment of migraine.

DHE IV is contraindicated in pregnant women because they reduce uterine blood flow and increase uterine muscle contractility which may most likely induce spontaneous abortion. It is not recommended during lactation because it can lead to gastrointestinal distress and weakness in newborns; and also can suppress milk production. The study authors further add, “The patients with cardiovascular risk (vasoconstriction) need to be careful before the administration of DHE.”