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.