China
Africa
Explore chapters and articles related to this topic
Pharmacological Treatment of Orthostatic Hypotension
Published in David Robertson, Italo Biaggioni, Disorders of the Autonomic Nervous System, 2019
Dihydroergotamine has proven useful in several trials at doses of 10-40 mg daily (Nordenfelt and Mellander, 1972; Bevegard, Castenfors and Lindblad, 1974; Tikholov, 1976; Jennings, Ester and Holmes, 1979; Benowitz et al., 1980). A trial of inhaled dihydroergotamine, in order to improve bioavailability, showed promise for this agent (Biaggioni et al., 1990). Caffeine 250 mg p.o. in combination with subcutaneous dihydroergotamine led to improved symptoms and prevented postprandial hypotension (Hoeldtke et al., 1986). Side effects such as angina or myocardial infarction secondary to the raised pressures and vasoconstriction actions may occur (Benedict and Robertson, 1979). Ergotamine, useful in treating migraines, has better bioavailability than dihydroergotamine and has been tried (Chobanian etal., 1983).
Trigeminal autonomic cephalgias I – cluster headache: diagnosis and treatment
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Dihydroergotamine given repetitively intravenously every 8-hours in an inpatient setting is an effective treatment for intractable cluster headache, rendering most patients headache-free during treatment. This approach will provide weeks or months in which to consider the options without the pressure of a patient in daily agony. Most such patients will have received multiple medications, including ergotamine (oral and suppository), steroids, and even intramuscular DHE, but remain refractory until intravenous DHE therapy is initiated.138 Histamine desensitization has been used to treat patients with intractable cluster headache with mixed results.139 Local steroid and anesthetic injection of the ipsi-lateral occipital nerve has been advocated, with headache relief for 5–73 days.93 Many patients required more than one injection. In our experience, and that of others, local steroid injections can be effective and buy valuable time while devising a further plan of management.
Headache
Published in John W. Scadding, Nicholas A. Losseff, Clinical Neurology, 2011
Some patients will require admission for detoxification. This broadly includes two groups, those who fail outpatient withdrawal or who have a significant complicating medical indication, such as brittle diabetes mellitus, where withdrawal may be problematic as an outpatient. When such patients are admitted, acute medications are withdrawn completely on the first day, unless there is some contraindication. Anti-emetics, preferring domperidone oral or suppositories, and fluids are administered as required, as well as clonidine for opiate withdrawal symptoms. For acute intolerable pain during the waking hours, intravenous aspirin (1 g intravenously) is useful and at night chlorpromazine by injection, ensuring adequate hydration. If the patient does not settle over 3–5 days, a course of intravenous dihydroergotamine (DHE) should be given. It is increasingly evident that DHE is indispensable in this setting; administered 8-hourly for 3 days, it can induce a significant remission that allows a preventive treatment to be established. Often 5-HT3 antagonists, such as ondansetron or granisetron, will be required with DHE as it is essential to ensure that the patient does not have significant nausea.
Tolerability of pharmacological agents in the treatment of headache following brain injury: a scoping review
Published in Brain Injury, 2023
Heather M. MacKenzie, Michael Robinson, Amanda McIntyre
A pre-post study (level 4 evidence) (17) examined the effect of repetitive intravenous (IV) dihydroergotamine (DHE) 0.5 mg in 34 subjects; IV metoclopramide 10 mg was given concurrently for prevention of nausea and vomiting. In this study, the medications were administered by “slow push” (IV direct) every 8 hours for 24–48 hours depending on clinical response. The subjects were admitted to hospital to receive treatment and monitoring. Following discharge, the subjects were prescribed a tricyclic antidepressant in combination with a beta-blocker or a calcium channel blocker for maintenance therapy. Most of the subjects (28/33; 85%) demonstrated good to excellent relief of their headaches with IV DHE (i.e., marked improvement or became symptom free). No serious side effects were noted related to the DHE administration but 30% (10/33) reported mild nausea and 12% (4/33) reported brief worsening of their headache after receiving DHE. No tolerability information was presented for the agents prescribed for maintenance therapy.
Cluster headache therapies: pharmacology and mode of action
Published in Expert Review of Clinical Pharmacology, 2020
Jasper Mecklenburg, Margarita Sanchez Del Rio, Uwe Reuter
Ergot derivates can be seen as the precursors of the triptans, as the mode of action is similar. They have widely been replaced by triptans. The mode of action for ergot derivates is believed to be similar to the triptans, as they bind nonspecific to 5-HT receptors. Therefore, their efficacy is probably due to their agonist activity at 5‐HT1B, 5‐HT1D, and 5‐HT1F receptors [85]. Their side effect profiles are secondary to their activity at 5‐HT1A, 5‐HT2A, and dopamine D2 receptors and include severely decreased blood flow, dysphoria, nausea, vomiting, and dysesthesia [86]. In the early 20th century, isolated ergotamine tartrate was one of the first drugs specifically used for primary headaches [87]. The development of dihydroergotamine (DHE) led to a more beneficial side effect profile. Recently the intranasal application of DHE is receiving more attention and is currently studied in migraine [88].
Menstrual migraine: a review of current and developing pharmacotherapies for women
Published in Expert Opinion on Pharmacotherapy, 2018
G. Allais, Giulia Chiarle, Silvia Sinigaglia, Chiara Benedetto
D’Alessandro et al. [94] evaluated the use of slow-release dihydroergotamine (DHE) 3.5 mg in 20 women with MM administered every 12 h starting from 2 days before the first day of menses for a total of 5 days. The results after 5 months of treatment showed a reduction in migraine duration from 28.56 ± 2.20 to 17.18 ± 3.40 h (p < 0.01) and in attack severity (reduction in headache index from 69.1 to 28.0 points, p < 0.001). The efficacy of slow-release DHE 10 mg was tested in 9 women with MM starting from the 23rd day of the cycle for 6 days during 3 consecutive cycles. A reduction in the PTI was recorded already at 1 month into therapy (from 199.8 to 25.3 points, p < 0.001) and maintained over the subsequent months (p < 0.001) [95].