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Peter J. Goadsby - One of the best experts on this subject based on the ideXlab platform.
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Increased rate of venous thrombosis may be associated with inpatient Dihydroergotamine treatment.
Neurology, 2017Co-Authors: Amy R. Tso, Irene Patniyot, Amy A. Gelfand, Peter J. GoadsbyAbstract:Objective: To review whether the incidence of catheter-associated venous thromboses was higher in patients receiving IV Dihydroergotamine compared to lidocaine. Methods: We retrospectively reviewed all admissions at the University of California, San Francisco Headache Center from February 25, 2008, through October 31, 2014, for age, sex, diagnosis, aura, treatment dose, type of IV line used, days with line, superficial (SVT) or deep venous thrombosis (DVT), and pulmonary embolism (PE). Results: A peripherally inserted central catheter (PICC) or midline catheter was placed in 315 of 589 (53%) admissions. Mean age was 38 years with a range of 6 to 79 years; 121 patients (21%) were ≤18 years old. Seventy-four percent (433 of 589) of patients were female. Of 263 Dihydroergotamine admissions using a PICC or midline catheter, 19 (7.2%) had either an SVT or DVT or a PE; 2 patients were diagnosed with both DVT and PE. Of 52 lidocaine admissions using a PICC or midline catheter, none had a thrombotic event (p = 0.05, Fisher exact test). Age, sex, aura, total Dihydroergotamine dose, and number of days with line were not significant predictors of venous thrombosis. Conclusions: IV Dihydroergotamine treatment may be associated with an increased risk of catheter-associated venous thrombosis. A low threshold for diagnostic ultrasound investigation is appropriate because anticoagulation therapy was frequently required.
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Intravenous Dihydroergotamine for inpatient management of refractory primary headaches
Neurology, 2011Co-Authors: Abraham J. Nagy, Sonia Gandhi, Ria Bhola, Peter J. GoadsbyAbstract:Objective: To determine dosing and side effects of Dihydroergotamine as they affect outcomes in primary headache disorders. Methods: We audited our use of Dihydroergotamine for inpatient management of disabling primary headache, focusing on the commonly treated problems. Results: Of patients interviewed, 114 had chronic migraine, 38 had cluster headache, and 11 had new daily persistent headache (NDPH). The mean time to follow-up for the entire cohort was 11 months. The data suggest that IV Dihydroergotamine given over 5 days produces improvement in headache and disability in patients with migraine more than shorter courses. It does so with a cumulative effect after discharge up to a month. Giving more Dihydroergotamine predicts a greater pain-free rate. Patients with cluster headache benefit from IV Dihydroergotamine. In patients with NDPH, only those with migrainous symptoms responded and in that group the response was less robust compared with that seen in the chronic migraine cohort. Conclusions: Intravenous Dihydroergotamine is well-tolerated, and longer treatments produce a better outcome. Nausea is the most common adverse effect, and its control is associated with a better outcome.
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the trigeminovascular system and migraine studies characterizing cerebrovascular and neuropeptide changes seen in humans and cats
Annals of Neurology, 1993Co-Authors: Peter J. Goadsby, Lars EdvinssonAbstract:Both clinical and physiological consideration of migraine suggests that the pathophysiology of the syndrome is intimately linked to the trigeminal innervation of the cranial vessels, the trigeminovascular system. Studies were conducted on cats and humans to examine the interaction of these systems with the effective acute antimigraine drugs Dihydroergotamine and sumatriptan. In the animal studies cats were anesthetized and prepared for routine physiological monitoring as well as for blood sampling from the external jugular veins. Cerebral blood flow was monitored continuously using laser Doppler flowmetry and the effect of trigeminal ganglion stimulation on both cerebral blood flow and jugular vein peptide levels determined prior to and after administration of either sumatriptan or Dihydroergotamine. Stimulation of the trigeminal ganglion led to a frequency-dependent increase in cerebral blood flow, with a mean maximum of 43 ± 9% at a stimulus frequency of 20 per second. There was a marked reduction in these responses by some 50% after administration of either sumatriptan or Dihydroergotamine. Trigeminal ganglion stimulation at a frequency of 5 per second also led to a release into the cranial circulation of calcitonin gene–related peptide (CGRP), with the level rising from 67 ± 3 to 82 ± 5 pmol/liter on the side of stimulation. These increases were also markedly antagonized by both sumatriptan and Dihydroergotamine. Human studies were conducted as part of the overall evaluation of sumatriptan for the treatment of acute migraine. In 7 of 8 patients responding to subcutaneous sumatriptan administration, elevated CGRP levels (60 ± 8 pmol/liter) were normalized, with the headache being relieved (40 ± 8 pmol/liter). These data characterize some aspects of the cerebrovascular physiology of the trigeminovascular system and demonstrate important interactions between this system and the effective antimigraine agents sumatriptan and Dihydroergotamine and that such interactions can be represented in animal models.
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Localization of 3H‐Dihydroergotamine‐binding sites in the cat central nervous system: Relevance to migraine
Annals of Neurology, 1991Co-Authors: Peter J. Goadsby, Andrew L. GundlachAbstract:Dihydroergotamine (DHE) is the treatment of choice in aborting the acute attack of migraine. Although its efficacy has been known for 40 years, its mechanism of action is still disputed. Data regarding the site of action of Dihydroergotamine may provide an insight into its mechanism of action and thus identify a locus of potentially abnormal pathophysiology in migraine. By using in vitro and ex vivo autoradiographic techniques, the localization of specific binding sites for 3H-Dihydroergotamine in the cat brain has been examined. Binding was seen in the dorsal horn of the cervical spinal cord, in the medulla, associated with the nucleus of the tractus solitarius, area postrema, and descending spinal trigeminal nucleus, and in the mesencephalon and the cerebral cortex. The highest density of binding sites was found in the dorsal and medial raphe nuclei of the midbrain. Furthermore, these same brain regions were also labeled after intravenous administration of 3H-Dihydroergotamine. It is important that the brain areas specifically labeled are key nuclei involved in cranial pain transmission, suggesting that Dihydroergotamine may act at these central sites in migraine.
B Margul - One of the best experts on this subject based on the ideXlab platform.
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a double blind study of subcutaneous Dihydroergotamine vs subcutaneous sumatriptan in the treatment of acute migraine
JAMA Neurology, 1996Co-Authors: Paul Winner, O Ricalde, Le B Force, Joel Saper, B MargulAbstract:Objective: To assess the efficacy and tolerability of subcutaneous Dihydroergotamine mesylate (DHE-45) vs subcutaneous sumatriptan succinate (Imitrex) for the treatment of acute migraine with or without aura. Design: Double-blind, randomized trial with parallel treatment arms. Setting: Clinics and private neurology practices. Subjects: Patients of either sex, with migraine with or without aura, between the ages of 18 and 65 years. Interventions: Patients with moderate or severe head pain were randomized to receive either 1 mg of subcutaneous Dihydroergotamine mesylate or 6 mg of subcutaneous sumatriptan succinate. Patients rated head pain, functional ability, nausea, and vomiting at baseline and at 0.5, 1, 2,4, and 24 hours after the injection. Presence or absence of headache at 3 hours was calculated from collected data. If pain persisted after 2 hours, a second injection of the same study medication was allowed, and self-ratings were repeated 30 and 60 minutes later. Follow-up data were collected at 24 hours. Main Outcome Measures: Relief of head pain and recurrence of successfully treated headache. Results: There were 295 evaluable patients. At 2 hours, 73.1% of the patients treated with Dihydroergotamine and 85.3% of those treated with sumatriptan had relief ( P =.002). There was no statistical difference in headache relief between the groups at 3 or 4 hours. Headache relief was achieved by 85.5% of those treated with Dihydroergotamine and by 83.3% of those treated with sumatriptan by 4 hours. By 24 hours 89.7% of Dihydroergotamine-treated patients and 76.7% of sumatriptan-treated patients had relief ( P =.004). Headache recurred within 24 hours after treatment in 45% of the sumatriptan-treated patients and in 17.7% of the Dihydroergotamine-treated patients ( P ≤.001). Conclusions: Both sumatriptan and Dihydroergotamine were effective in aborting migraine headaches. Headache recurrence was two and a half times as likely with sumatriptan as with Dihydroergotamine.
Paul Winner - One of the best experts on this subject based on the ideXlab platform.
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Subcutaneous Dihydroergotamine vs Subcutaneous Sumatriptan-Reply
Archives of Neurology, 1996Co-Authors: Paul Winner, Joel SaperAbstract:In reply The first double-blind randomized study directly comparing subcutaneous Dihydroergotamine with subcutaneous sumatriptan in the treatment of acute migraine 1 clearly describes the treatment groups with the main outcome measures of pain relief and recurrence of successfully treated headaches emphasized. The conclusions of this article note that the "onset of relief with sumatriptan was more rapid, but by 3 hours Dihydroergotamine and sumatriptan were equally efficacious" and "relief with Dihydroergotamine was more sustained." Headache resolution was noted by both graphics and narrative to be 56.6% for the Dihydroergotamine group and 78% for the sumatriptan group at 1 hour, and at 2 hours headache relief was 73% and 85%, respectively, which statistically significantly favored the sumatriptan group in the first 2 hours. Our selection of the 2-hour evaluation point in the abstract is consistent with the guidelines for controlled trials of "drugs in migraine" 2 that recommends, "Number of migraine
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a double blind study of subcutaneous Dihydroergotamine vs subcutaneous sumatriptan in the treatment of acute migraine
JAMA Neurology, 1996Co-Authors: Paul Winner, O Ricalde, Le B Force, Joel Saper, B MargulAbstract:Objective: To assess the efficacy and tolerability of subcutaneous Dihydroergotamine mesylate (DHE-45) vs subcutaneous sumatriptan succinate (Imitrex) for the treatment of acute migraine with or without aura. Design: Double-blind, randomized trial with parallel treatment arms. Setting: Clinics and private neurology practices. Subjects: Patients of either sex, with migraine with or without aura, between the ages of 18 and 65 years. Interventions: Patients with moderate or severe head pain were randomized to receive either 1 mg of subcutaneous Dihydroergotamine mesylate or 6 mg of subcutaneous sumatriptan succinate. Patients rated head pain, functional ability, nausea, and vomiting at baseline and at 0.5, 1, 2,4, and 24 hours after the injection. Presence or absence of headache at 3 hours was calculated from collected data. If pain persisted after 2 hours, a second injection of the same study medication was allowed, and self-ratings were repeated 30 and 60 minutes later. Follow-up data were collected at 24 hours. Main Outcome Measures: Relief of head pain and recurrence of successfully treated headache. Results: There were 295 evaluable patients. At 2 hours, 73.1% of the patients treated with Dihydroergotamine and 85.3% of those treated with sumatriptan had relief ( P =.002). There was no statistical difference in headache relief between the groups at 3 or 4 hours. Headache relief was achieved by 85.5% of those treated with Dihydroergotamine and by 83.3% of those treated with sumatriptan by 4 hours. By 24 hours 89.7% of Dihydroergotamine-treated patients and 76.7% of sumatriptan-treated patients had relief ( P =.004). Headache recurred within 24 hours after treatment in 45% of the sumatriptan-treated patients and in 17.7% of the Dihydroergotamine-treated patients ( P ≤.001). Conclusions: Both sumatriptan and Dihydroergotamine were effective in aborting migraine headaches. Headache recurrence was two and a half times as likely with sumatriptan as with Dihydroergotamine.
Vinicio Granadossoto - One of the best experts on this subject based on the ideXlab platform.
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role of 5 ht1b 1d receptors in the reduction of formalin induced nociception and secondary allodynia hyperalgesia produced by antimigraine drugs in rats
Life Sciences, 2013Co-Authors: Beatriz Godinezchaparro, Francisco J Lopezsantillan, Carlos F Arguelles, Carlos M. Villalón, Vinicio GranadossotoAbstract:Abstract Aims The present study analyzed the potential antinociceptive effect of the antimigraine drugs sumatriptan, Dihydroergotamine or methysergide in rats submitted to the formalin test. Moreover, by using selective antagonists, the role of 5-HT 1B/1D serotonergic receptors was investigated in the antinociception induced by these antimigraine drugs. Main methods The formalin test was used to assess the nociceptive activity. Overt pain-like behavior (flinching, 1 h) and evoked nociception (long-lasting secondary mechanical allodynia and hyperalgesia, 6 days) were determined in the same rat. Key findings Ipsilateral, but not contralateral, pre-treatment (in μg/paw) with sumatriptan (10–300), methysergide (1–30) or Dihydroergotamine (1–30) significantly prevented flinching behavior (at 1 h) as well as secondary allodynia and hyperalgesia (at day 6) induced by formalin. Interestingly, the antinociceptive (flinching), antiallodynic and antihyperalgesic effects of sumatriptan were completely prevented by peripheral pre-treatment with selective antagonists at the 5-HT 1B (SB 224289; 100) or 5-HT 1D (BRL 15572; 100) receptors. In contrast, the acute antinociceptive effects of methysergide and Dihydroergotamine were partially prevented by SB 224289 and BRL 15572. The antiallodynic and antihyperalgesic effects of both drugs were completely prevented by BRL 15572 and partially prevented by SB 224289. Given alone, SB 224289 or BRL 15572 did not modify per se the long-lasting secondary allodynia and hyperalgesia. Significance The above findings suggest that: (i) the antimigraine drugs sumatriptan, methysergide and Dihydroergotamine reduce the acute and chronic nociception induced by formalin; and (ii) this antinociceptive effect results from activation of peripheral 5-HT 1B/1D serotonergic receptors.
Joel Saper - One of the best experts on this subject based on the ideXlab platform.
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Subcutaneous Dihydroergotamine vs Subcutaneous Sumatriptan-Reply
Archives of Neurology, 1996Co-Authors: Paul Winner, Joel SaperAbstract:In reply The first double-blind randomized study directly comparing subcutaneous Dihydroergotamine with subcutaneous sumatriptan in the treatment of acute migraine 1 clearly describes the treatment groups with the main outcome measures of pain relief and recurrence of successfully treated headaches emphasized. The conclusions of this article note that the "onset of relief with sumatriptan was more rapid, but by 3 hours Dihydroergotamine and sumatriptan were equally efficacious" and "relief with Dihydroergotamine was more sustained." Headache resolution was noted by both graphics and narrative to be 56.6% for the Dihydroergotamine group and 78% for the sumatriptan group at 1 hour, and at 2 hours headache relief was 73% and 85%, respectively, which statistically significantly favored the sumatriptan group in the first 2 hours. Our selection of the 2-hour evaluation point in the abstract is consistent with the guidelines for controlled trials of "drugs in migraine" 2 that recommends, "Number of migraine
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a double blind study of subcutaneous Dihydroergotamine vs subcutaneous sumatriptan in the treatment of acute migraine
JAMA Neurology, 1996Co-Authors: Paul Winner, O Ricalde, Le B Force, Joel Saper, B MargulAbstract:Objective: To assess the efficacy and tolerability of subcutaneous Dihydroergotamine mesylate (DHE-45) vs subcutaneous sumatriptan succinate (Imitrex) for the treatment of acute migraine with or without aura. Design: Double-blind, randomized trial with parallel treatment arms. Setting: Clinics and private neurology practices. Subjects: Patients of either sex, with migraine with or without aura, between the ages of 18 and 65 years. Interventions: Patients with moderate or severe head pain were randomized to receive either 1 mg of subcutaneous Dihydroergotamine mesylate or 6 mg of subcutaneous sumatriptan succinate. Patients rated head pain, functional ability, nausea, and vomiting at baseline and at 0.5, 1, 2,4, and 24 hours after the injection. Presence or absence of headache at 3 hours was calculated from collected data. If pain persisted after 2 hours, a second injection of the same study medication was allowed, and self-ratings were repeated 30 and 60 minutes later. Follow-up data were collected at 24 hours. Main Outcome Measures: Relief of head pain and recurrence of successfully treated headache. Results: There were 295 evaluable patients. At 2 hours, 73.1% of the patients treated with Dihydroergotamine and 85.3% of those treated with sumatriptan had relief ( P =.002). There was no statistical difference in headache relief between the groups at 3 or 4 hours. Headache relief was achieved by 85.5% of those treated with Dihydroergotamine and by 83.3% of those treated with sumatriptan by 4 hours. By 24 hours 89.7% of Dihydroergotamine-treated patients and 76.7% of sumatriptan-treated patients had relief ( P =.004). Headache recurred within 24 hours after treatment in 45% of the sumatriptan-treated patients and in 17.7% of the Dihydroergotamine-treated patients ( P ≤.001). Conclusions: Both sumatriptan and Dihydroergotamine were effective in aborting migraine headaches. Headache recurrence was two and a half times as likely with sumatriptan as with Dihydroergotamine.