Repeated IV infusions of DHE (dihydroegotamine) is the standard treatment for breaking transformed migraines (into chronic daily headaches). Unfortunately, arranging patient to be seen every 8 hours is just not viable in our community. Now a continuous infusion protocol may make this procedure more available.
Headache. 2010 Jan 28. [Epub ahead of print]
Outpatient Home-Based Continuous Intravenous Dihydroergotamine Therapy for
Intractable Migraine.
Charles JA, von Dohln P. abstract here
IV program is:
1. Start IV for administration of DHE 3 mg in 1000 mL of normal saline.
2. Begin DHE 3 mg in 1000 mL of normal saline at 42 mL/hour on day 1 and day 2; DHE
1.5 mg in 1000 mL of normal saline was infused at 21 mL/hour on day 3. – by infusion pump put on waist or shoulder.
3. Give metoclopramide 10 mg IV in 50 mL of normal saline over 30 minutes one-half hour prior to initiation of the infusion on day 1. Thereafter, may use metoclopramide 10 mg oral tablets every 8 hours PRN for nausea not to exceed 30 mg per 24 hours.
4. Give loperamide 2-4 mg bid prn diarrhea.
5. If significant nausea, leg cramping, or vomiting occurs, decrease the infusion to 21-30 mL per hour.
6. If patient develops chest pain discontinue DHE infusion.
Results –
- average of 63.4% reduction in the intensity of migraine pain by the end of the 3-day
- . Side effects were minimal
- ~ one-third of patients became completely headache-free after day 3,
- “Long-term follow-up data indicated an average 86% reduction in headache frequency and almost every patient converted from chronic daily headache to episodic migraine except for 1 patient.”
- “Patients with medication overuse headache were no longer consuming the daily offending medication.”
I have used this is chronic daily headaches but used intranasal DHE or DHE self administered shots. Trying to get emergency to administer IV’s just creates headaches as they could wait hours for their IV. The addition of dexamethasone helps but has to be given separately (precipitates). It would also seem likely that an IV syringe pump may also work – putting 3 mg in 60 mls. saline and run at 2.5 mls/hour.
Now if I can get my health district to administer it…
Any comments on approaches used etc?