Lower extremity ischemia due to combined drug therapy for migraine

Abstract

Three days after initiation of migraine headache therapy with ergotamine tartrate and propranolol, severe acute arterial insufficiency of the lower extremities developed in a 48-year-old woman who had been in general good health. Angiography revealed hypoplastic aortoiliac arteries, with tubular narrowing of the leg arteries. Lower extremity blood pressures rapidly returned to normal with a single intraarterial injection of 25 mg of tolazoline. Cases of peripheral ischemia due to either ergotamine or propranolol have been reported. Combined use of these two drugs may enhance the risk of acute arterial compromise.

Myocardial Ischemia Related to Ergot Alkaloids: A Case Report and Literature Review

“…Peripheral arterial insufficiency has been reported both as an isolated phenomenon and as a concomitant of heart disease with different routes of ergotamine administration. 4,14,[16][17][18][19] Several reports also describe recurrent attacks of angina following the administration of ergotamine, 3,4,5,7,8,11,12 as observed in our patient. The mechanism responsible for these repetitive ischemic attacks is not known.…”