Document Detail


Appropriate use of ergotamine tartrate and dihydroergotamine in the treatment of migraine: current perspectives.
MedLine Citation:
PMID:  9009473     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Considerable uncertainty exists regarding the appropriate use and dose limitations for ergotamine tartrate (ET) and dihydroergotamine (DHE) for the treatment of migraine despite more than 50 years of clinical experience. The Quality Standards Subcommittee (QSS) of the American Academy of Neurology (AAN) appointed an advisory committee from experts in the Headache and Facial Pain Section. As their initial project, the committee elected to review the clinical literature on the appropriate use of these compounds in the treatment of migraine. Subsequently, clinical practice guidelines were formulated and recently published in Neurology. The Headache and Facial Plan Section and the QSS of the AAN were able to reach consensus on the basis of a thorough literature review and formulated practice parameters that describe and define the limits of ergot use, provide information on the oral and parenteral dosing of ET and DHE, and provide physicians with guidance to avoid ET overuse by patients. Because this project was completed prior to the availability of the intranasal (IN) formulation of DHE, intranasal DHE is not included in the practice parameter. Ergotamine tartrate and DHE were found to be safe and effective for the treatment of migraine as long as recommended dosages are not exceeded and high-risk patients such as those with uncontrolled hypertension, coronary or peripheral artery disease, thyrotoxicosis, or sepsis do not receive these compounds. In addition, the committee recommended restricting the use of ET in some instances because the overuse of ET has been associated with physical and psychological dependence resulting in predictable recurrent and/or rebound headaches, and subsequent severe withdrawal symptoms, including nausea, upon discontinuance of ET. None of these symptoms have been reported for DHE. These guidelines should help physicians provide optimal antimigraine therapy with these drugs.
Authors:
W B Young
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Headache     Volume:  37 Suppl 1     ISSN:  0017-8748     ISO Abbreviation:  Headache     Publication Date:  1997  
Date Detail:
Created Date:  1997-02-18     Completed Date:  1997-02-18     Revised Date:  2009-02-02    
Medline Journal Info:
Nlm Unique ID:  2985091R     Medline TA:  Headache     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  S42-5     Citation Subset:  IM    
Affiliation:
Department of Neurology, Germantown Hospital and Medical Center, Philadelphia, PA 19144, USA.
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MeSH Terms
Descriptor/Qualifier:
Analgesics, Non-Narcotic / contraindications,  therapeutic use*
Dihydroergotamine / contraindications,  therapeutic use*
Ergotamine / contraindications,  therapeutic use*
Humans
Migraine Disorders / drug therapy*
Practice Guidelines as Topic
Chemical
Reg. No./Substance:
0/Analgesics, Non-Narcotic; 113-15-5/Ergotamine; 511-12-6/Dihydroergotamine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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