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The Black Death and Other Pandemics
Published in Scott M. Jackson, Skin Disease and the History of Dermatology, 2023
Toxicity from consumption of substantial amounts of ergotamine can manifest as severe limb pain and peripheral vasoconstriction (gangrenous ergotism), or seizures, muscle spasms, delusion, confusion, and hallucinations (convulsive ergotism). The prevalence of ergotism among the poor is explained by the tendency of the poor to consume spurred rye. The dissimilarity in the manifestations of ergotism east and west of the Rhine remains somewhat of a mystery. Modern researchers suggest that it was variability in the concentration of ergot alkaloids in the grain due to various reasons: regional differences in the strains of C. purpurea, differences in the soil or habitat where the grain was grown and stored, and degradation of the ergot over time after prolonged storage.66 Less rye was grown in Italy in the Middle Ages; hence, St. Anthony's Fire was not mentioned in medieval Italian chronicles.67
Valve Disease
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Serotonergic drugs previously used in Parkinson's disease, such as pergolide, have been associated with valvular myxoid thickening and regurgitation in both mitral and aortic valves. Use of fenfluramines, either alone or co-administered with phentermine (‘fen-phen’) as anorexic agents in obesity, has been associated with similar changes. Ergotamine used in treating migraines gives a similar picture. Macroscopic changes include irregular leaflet thickening, accompanied by chordal fusion in the mitral valve, with no commissural fusion or evidence of annular dilation. The heart valves have a glistening white appearance. Histopathological findings show plaque-like encasement of the leaflets and chords with intact valve architecture. The histopathological features are identical to those seen in carcinoid-induced valve disease.
Headache
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
None of these agents are consistently effective in all patients and all attacks, and some cause disturbing adverse effects. Moreover, given individual variation, each triptan has a role in particular patients, and this can only be determined by use. In general terms, rizatriptan 10 mg and eletriptan 80 mg provide the highest likelihood of success. Ergotamine and sumatriptan should not be prescribed for patients with suspected coronary artery disease, Prinzmetal's variant angina, or uncontrolled hypertension.
Current advances in the management of cluster headaches
Published in Expert Opinion on Pharmacotherapy, 2021
Theodoros Mavridis, Marianthi Breza, Christina Deligianni, Dimos D. Mitsikostas
Ergot derivatives such as oral ergotamine and intranasal or intravenous dihydroergotamine (DHE) have been used as a treatment for CH bouts but with little evidence of clear efficacy. The initial dose of oral ergotamine is 2 mg sublingual and can be repeated every 30 minutes with a max dose of 6 mg daily. Intranasal DHE has a level U recommendation from the AHS [29], denoting insufficient evidence to make. Intravenous DHE has shown better results for inpatient management of the refractory episodic CH [40]. The initial dose of DHE is 1 mg IV bolus and can be repeated after 1 hour with a max dose of 3 mg per day. Ergots can also induce medication overuse headache (MOH) with very low doses and their use must be limited to less than 10 days per month. Contraindications are coronary artery disease due to the constriction of the coronal vessels [41], arterial hypertension, and cerebrovascular diseases. Due to their impact on the vascular system, they should not be used in combination with other vasoconstrictor drugs. Other contraindications include Raynaud disease, renal or hepatic failure, pregnancy, and lactation [27,36].
Are 5-HT1 receptor agonists effective anti-migraine drugs?
Published in Expert Opinion on Pharmacotherapy, 2021
Masaru Tanaka, Nóra Török, László Vécsei
The ergot alkaloid ergotamine is an antimigraine drug isolated from the ergot fungus in 1918, which targets 5-HT1/2-, adrenaline-, and dopamine receptors (Figure 1). Dihydroergotamine relieves migraine headache through the activation of 5-HT1D receptors of intracranial blood vessels, which leads to vasoconstriction, and increase of 5-HT1D receptor expression of the trigeminal sensory nerve endings, which leads to the inhibition of the release of inflammatory neuropeptides, such as CGRP (Table 1 and Table 2). Furthermore, ergotamine targets 5-HT1B receptor, 5-HT2A receptor, and adrenergic receptors alpha (α) 1A/B/D subtypes, prolonging vasoconstriction through the inhibition of norepinephrine uptake and stimulation of α -adrenergic receptors. Generally, ergotamine is not considered as the first-line treatment for migraine [3].
Can Psychedelics Alleviate Symptoms of Cluster Headache and Accompanying Mental Health Problems? A Case Report Involving Hawaiian Baby Woodrose
Published in Journal of Psychoactive Drugs, 2020
Shevaugn Johnson, Quentin C. Black
This case report also highlights a potential link between herpes viruses and cluster headache. The patient’s history of ipsilateral herpetic facial lesions and additional exposure to shingles through her daughter in the weeks preceding the onset of left-sided facial pain suggest such an association. Furthermore, her resolution of cluster headache pain with antiviral treatment points to an etiology of symptoms in her case. While there is not a lot of research reporting on the link between the herpes simplex virus and symptoms of cluster headache, there is some case report evidence in the literature (Joseph and Rose 1985; Sacquegna et al. 1982). It is interesting to note that the authors of one of these case reports also used an ergotamine to manage the client’s symptoms (Joseph and Rose 1985). Ergotamine tartrate is one such agent, first reported as a cluster headache preventive in 1947 (Selby 1983). Furthermore, antiviral properties have been reported in the Hawaiian baby woodrose literature (Joseph et al. 2011), although a 2010 review did not detect any antiviral properties in the Argyreia speciosa seed extracts (Galani, Patel, and Patel 2010).