The effectiveness of
dihydroergotamine administered by home
subcutaneous injection by the patient or family for severe
headache attacks was assessed retrospectively in 51 patients. Average follow-up was 21 weeks. Twenty-one patients had intermittent
migraine attacks, 27 had transformed
migraine with
chronic daily headache, and 3 had chronic
tension-type headache. Of the 51 patients taught home injection, 35% had an excellent overall response, 18% had a good response, 12% had a poor response but continued to use
dihydroergotamine, and 35% had discontinued
dihydroergotamine use. Side effects were the main reason for stopping
dihydroergotamine. These included
nausea or
vomiting or both, limb
pain or
numbness or both, chest or throat tightness or both, and soreness at the injection site. Thirty-three patients (65%) continued to use
dihydroergotamine at the end of the follow-up period. In patients who previously required
injections from medical personnel for
headache crises and in whom home injection of
dihydroergotamine was effective, a dramatic reduction occurred in hospital emergency room and physician office utilization.
Dihydroergotamine use by home injection can be an effective treatment for a significant proportion of patients with severe
migraine including patients with transformed
migraine and
medication overuse.