Injectable or Nasal DHE for Migraines

How It's Given, and What to Watch Out For

Woman suffering from migraine
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Dihydroergotamine (DHE) is a prescription medication used to relieve acute migraine attacks. It is among the most effective migraine treatments, and it is safe for most people. If your doctor has given you a prescription for DHE, you may want to know more about this medication, including how it works and how to recognize its side effects.

Indications

DHE is used for the treatment of moderate and severe migraine attacks. You can take it on your own if you have a prescription or you may receive the medication in the emergency room or urgent care.

DHE is fast acting, and it is commonly used in the emergency room setting for rapid migraine relief, such as in the treatment of status migrainous.

DHE can be particularly effective in treating menstrual migraines and medication overuse headaches. You and your doctor might consider it a good option for you if you experience severe nausea or vomiting with your migraines because it is not taken by mouth.

You can use DHE before your migraine begins, during the prodromal phase, or during the migraine attack itself. Some people notice that taking it during the prodromal phase can prevent a migraine from progressing, whereas others notice that the medication wears off when taken too soon.

The best strategy is to take DHE as soon as you sense that you will have a migraine and to discuss your response to the medication with your doctor as you decide on the best timing for you.

DHE does not prevent migraines, and it is not intended to be taken on a regular basis. Nor is it used to treat non-migraine headaches like tension headaches

Dose and Formulation

DHE can be administered intranasally (through the nose) or it can be injected intramuscularly (IM into the muscle) or intravenously (IV into a vein). This medication is not well absorbed orally (by mouth), so pill forms are not readily available in the United States.

  • Migranal is the nasal form of DHE
  • D.H.E 45 is the injectable form of DHE


If you are given a prescription for nasal or injectable DHE, your doctor's office can provide you with instructions and can help you learn how to use the medication on your own.

Ergotamines

You may have also heard of oral ergotamine medications, including Cafergot or Migergot, which are brands of ergotamine/ caffeine combinations. These medications contain ergotamine, which is similar to DHE.

How It Works

DHE has several actions on the body, and the migraine relieving effect may be the result of more than one of these actions. This medication generally relieves the pain, nausea, and other symptoms of a migraine.

Vasoconstriction, which is narrowing of the blood vessels, is the most recognized effect of DHE, and the most closely associated with migraine relief. Migraines are believed to involve vasodilation (widening of the blood vessels) in the blood vessels of the brain, and counteracting this effect is commonly relieves migraines, at least temporarily.

DHE has a lower risk of inducing medication overuse headaches than other migraine medications. A medication overuse headache occurs after the migraine medication wears off, and is often described as medication rebound headache or medication withdrawal headache.

The physiological mechanisms that cause DHE to have its effect on the body are:

  • It inhibits calcitonin gene-related peptide (CGRP). CGRP triggers inflammation, which may contribute to migraines.
  • It binds to serotonin receptors, which modulate pain and mood.
  • It binds to dopamine receptors, which can inhibit CRGP release and induce vasoconstriction.
  • It binds to adrenergic receptors, which induces vasoconstriction.

Side Effects and Contraindications

While it is relatively safe, DHE is not for everyone. It can produce a number of serious side effects and should not be taken with certain medications.

If you have had an allergic reaction to ergotamines, then DHE is not safe for you either.

Side Effects

It is important to seek medical attention if you experience any of the following symptoms within a few days of using DHE:

  • Numbness or tingling in fingers and toes
  • Pain, tightness, or discomfort in the chest
  • Muscle pain or cramps in arms and legs
  • Weakness in legs
  • Speeding or slowing of your heart rate
  • Swelling or itching
  • Dizziness
  • Trouble breathing
  • A worsening headache

Contraindications

You cannot use DHE if you are pregnant or breastfeeding. DHE is also contraindicated if you have certain medical conditions, including:

  • Heart disease
  • High blood pressure
  • A history of stroke
  • Hemiplegic or basilar migraine
  • Peripheral vascular disease
  • Impaired liver or kidney function

Medication Interactions

It's important to tell your doctor all of the medications you are taking, including over-the-counter supplements and vitamins. Some medications, particularly medications that induce vasoconstriction, cannot be used with DHE. If you are filling a prescription for DHE, check with your doctor or pharmacist to be sure that it does not interact with any of your other medications or supplements.

Be particularly attentive if you use any triptans for your migraines, as you cannot take DHE within 24 hours of taking a triptan because they are also vasoconstrictors.

A Word From Verywell

DHE is often considered second-line therapy for migraines because it does not come in an easy-to-use pill form. If you and your doctor decide that DHE is the right medication for you, it is recommended that you become familiar with the side effects so that you can recognize them and get medical attention in a timely manner if you develop any.

You can work with your doctor to create a healthy approach to caring for your migraines—including lifestyle strategies, possible prescription prevention, and a plan for acute therapy. Finding the right routine for your migraine care will go a long way in improving your quality of life.

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