Intravenous DHE demonstrates cardiac safety among patients with refractory migraine

A recent found the safety and efficacy of repetitive intravenous Dihydroergotamine (DHE) for migraine patients with cardiovascular risk factors, but without ischemic heart disease or coronary vasospasm. This research aimed to address the uncertainty surrounding DHE's application and the findings were published in Headache: The Journal of Head and Face Pain.

This single-center retrospective cohort analysis, examined patients suffering from refractory chronic migraines who underwent intravenous DHE treatment between January 2019 and October 2019. The primary objectives included assessing the safety, tolerability, and effectiveness of the treatment in individuals with atherosclerotic cardiovascular disease risk factors, categorized as either low (<5.0%) or elevated (≥5.0%).

The research encompassed 347 patients, mainly women (80.1%), with a median age of 46. Among these, 227 had calculable risk scores, with 28.2% classified as having elevated cardiovascular risk. Impressively, there were no significant electrocardiogram abnormalities or cardiovascular adverse events reported during the study.

The median hospital stay for these patients was six days. A noteworthy discovery was that patients with elevated cardiovascular risk experienced higher levels of nausea but received similar initial DHE doses as those with lower risk. However, they did receive lower final DHE doses and reported slightly less reduction in pain severity after admission compared to the low-risk group.

The study demonstrates that repetitive intravenous DHE treatment, administered according to the Jefferson Headache Center's protocol, effectively reduced pain severity in refractory chronic migraine patients. Importantly, this treatment approach was found to be safe for patients with high cardiovascular risk, as no clinically significant cardiac abnormalities or electrocardiogram irregularities were observed.

This research highlights the importance of individualized treatment plans and careful monitoring to ensure the best outcomes for migraine patients, even in the presence of cardiovascular risk factors. Further studies may continue to refine our understanding of this treatment's effectiveness and safety in this patient population.

Source:

Wang, V. S., Kosman, J., Yuan, H., Lauritsen, C., Shrewsbury, S., Aurora, S. K., Hopkins, M., & Silberstein, S. (2023). Safety, tolerability, and effectiveness of repetitive intravenous dihydroergotamine for refractory chronic migraine with cardiovascular risk factors: A retrospective study. In Headache: The Journal of Head and Face Pain. Wiley. https://doi.org/10.1111/head.14636