Outpatient Intravenous Dihydroergotamine for Refractory Cluster Headache

Magnoux, Eric; Zlotnik, Gregorio

doi:10.1111/j.1526-4610.2004.04055.x

Cited by 51 publications

(37 citation statements)

References 24 publications

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“…Magnoux was able to induce a remission of the chronic form of refractory cluster headache and transform it to the episodic form [10]. We accomplished analogous results with our adolescent chronic migraine series, but our study is obviously limited by the small number of patients.…”

Section: Discussionsupporting

confidence: 58%

Observations of the “carry–over effect” following successful termination of chronic migraine in the adolescent with short–term dihydroergotamine, dexamethasone and hydroxyzine: a pilot study

Charles

Jotkowitz

2005

J Headache Pain

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IntroductionDaily oral preventive therapies for frequent and/or disabling migraine attacks are fraught with possible adverse effects and drug-drug interactions. Curative therapy is non-existent.Sensitisation of peripheral and central nociceptors are common mechanisms contributing to the development of chronic pain and, along with other morphological changes J Headache Pain (2005) 6:51-54 DOI 10.1007 Observations of the "carry-over effect" following successful termination of chronic migraine in the adolescent with short-term dihydroergotamine, dexamethasone and hydroxyzine: a pilot study Abstract Chronic migraine management almost always requires daily oral preventative medication with potential adverse effects. Daily oral preventative therapy may also not be effective in terminating chronic migraine. Chronic central sensitisation caused by repetitive migraine attacks in a young person may lower the threshold for future migraine episodes leading to an intractable and debilitating disease course. The objective was to determine if short-term parenteral dihydroergotamine, dexamethasone and hydroxyzine can terminate chronic migraine and be followed by a continuous respite or conversion to a more benign episodic form without the need for daily oral preventative medication ("carry-over effect"). We treated ten patients, seven adolescents and three adults, with parenteral dihydroergotamine, dexamethasone and hydroxyzine given once a week for a maximum of three weeks. No oral preventative daily medication was administered. The setting was a private practice. Chronic migraine was terminated in all 7 adolescents. Their post-treatment course was converted to a more benign episodic migraine course and no adolescent required daily oral migraine preventative therapy for significantly long carry-over post-treatment observational periods. None of the three adult chronic migraine cases could be terminated satisfactorily as they all required daily oral preventative therapy. In the adolescent group only, this strategy terminated chronic migraine and resulted in a significant carry-over effect that appeared to favourably modify the long-term course without the need for daily pharmacological, potentially toxic, preventive therapy. Although this is a very small study, which requires confirmation by a larger controlled study, our data suggest a significant carryover effect in the young migraineur by administering short-term parenteral dihydroergotamine, dexamethasone and hydroxyzine.

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Section: Discussionsupporting

confidence: 58%

Observations of the “carry–over effect” following successful termination of chronic migraine in the adolescent with short–term dihydroergotamine, dexamethasone and hydroxyzine: a pilot study

Charles

Jotkowitz

2005

J Headache Pain

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“…At 12-month follow-up, 83% and 39% of patients with ECH and CCH, respectively, remained free of headache. A retrospective analysis evaluated the efficacy and safety of intravenous DHE for the treatment of refractory CH in 70 patients [31]. DHE led to complete resolution of the pain at 1 month after treatment in 62% of cases, partial improvement in 14%, and failure in 24%.…”

Section: Ergot Derivativesmentioning

confidence: 99%

Serotonergic Agents in the Management of Cluster Headache

Lambru

Matharu

2011

Curr Pain Headache Rep

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Cluster headache is a highly disabling primary headache disorder, characterized by unilateral headache attacks occurring in association with cranial autonomic symptoms. Serotonergic agents, such as the ergot alkaloids, have traditionally been used for the acute and preventive treatment of cluster headache and other primary headaches. Although it initially was thought that their efficacy was due solely to the vasoconstriction of extracranial cerebral vessels, new mechanisms of action of these drugs have been ascertained as a consequence of advances in elucidation of the pathogenesis of primary headaches and the development of triptans. This article reviews the current knowledge about serotonergic agonists and antagonists used in the management of cluster headache, focusing on their mechanisms of action and on the possible role of serotonin system dysfunction in this complex disorder.

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“…Dihydroergotamine was more effective for ECH than for CCH [24]: there was complete resolution in 73% of ECH patients and in 46% of CCH patients. Dihydroergotamine appeared to induce transformation from CCH to ECH: of the 17 patients with CCH who achieved complete success with dihydroergotamine, 3 experienced a transformation to ECH.…”

Section: Therapymentioning

confidence: 99%

Chronic cluster headache: a review

2005

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Cluster headache (CH) is a rare but severe headache disorder characterised by repeated unilateral head pain attacks accompanied by ipsilateral autonomic features. In episodic CH, there are periods of headache attacks with pain–free intervals of weeks, months or years in between. A minority of patients have the chronic form, without pain–free intervals between the headache attacks. Chronic CH can occur as primary or secondary chronic CH; the rarest form is episodic CH arising from chronic CH. In this article, we give a review of the chronic forms of CH and focus on demographics, clinical manifestations, social habits, predictive factors, head injury, genetics, neuroimaging and therapy. It is remarkable that little is known about risk factors that make CH chronic.

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Outpatient Intravenous Dihydroergotamine for Refractory Cluster Headache

Cited by 51 publications

References 24 publications

Observations of the “carry–over effect” following successful termination of chronic migraine in the adolescent with short–term dihydroergotamine, dexamethasone and hydroxyzine: a pilot study

Observations of the “carry–over effect” following successful termination of chronic migraine in the adolescent with short–term dihydroergotamine, dexamethasone and hydroxyzine: a pilot study

Serotonergic Agents in the Management of Cluster Headache

Chronic cluster headache: a review

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