Methylergonovine Maleate as a Cluster Headache Prophylactic: A Study and Review

Abstract

Methylergonovine maleate (Methergine), an ergot derivative with vasoconstrictive properties, has been cited as an effective treatment for vascular headaches. Few studies are available to support its use in headache management. An uncontrolled pilot study of 20 episodic cluster headache patients confirmed its effectiveness and tolerability as an adjunct cluster headache prophylactic. Decreased headache frequency was reported by 19 of 20 patients (95%), and 15 of 20 patients (75%) reported decreased intensity of headaches within 1 week of initiating therapy. A review of methylergonovine's pharmacokinetic, molecular, and tolerability profile clarifies its mechanisms and clinical role in headache management.

Serotonergic Agents in the Management of Cluster Headache

“…It was administered to 20 patients with ECH in an open-label study in 1997 [41]. Of the 20 patients, 19 (95%) reported a greater than 50% reduction in attacks within the first week.…”

Chronic Migraine

“…74 It has cholinergic side effects, such as nausea, vomiting, and diarrhea, as well as adverse events of dizziness and hypertension. It is contraindicated in pregnancy and pre-eclampsia.…”

Cluster Headache

“…Similar to methysergide, a drug-free hiatus every 6 months, and lasting for 1 month, should be followed with methylergonovine. 75 Another bridge is the use of oral triptans, including both sumatriptan and naratriptan. Sumatriptan, 100 mg, three times a day may be given as a preventive therapy, for up to 7 days of use.…”