D.H.E. 45

Cluster Headache, Migraine Disorders

Treatment

3 Active Studies for D.H.E. 45

What is D.H.E. 45

Dihydroergotamine

The Generic name of this drug

Treatment Summary

Dihydroergotamine is a medication used to treat migraines. It is not as commonly used as other medications like triptans because it has more side effects. Recent advancements in nasal delivery systems have improved the use of dihydroergotamine, increasing the amount of the drug that reaches the bloodstream. Impel Neuropharma recently developed a new delivery system, Precision Olfactory Delivery, which has been shown to increase the amount of dihydroergotamine in the bloodstream by three times.

Migranal

is the brand name

D.H.E. 45 Overview & Background

Brand Name

Generic Name

First FDA Approval

How many FDA approvals?

Migranal

Dihydroergotamine

1997

21

Effectiveness

How D.H.E. 45 Affects Patients

DHE is used to treat migraine headaches with or without an aura, as well as cluster headache episodes. It works by activating serotonin, which can reduce the amount of glutamate in the brain and help prevent migraine headaches. It also causes blood vessels to narrow, which can help reduce migraine pain and cause the side effect of chest tightness.

How D.H.E. 45 works in the body

DHE is believed to treat migraines in multiple ways. One way is by constricting the blood vessels that become widened during a migraine. It also blocks pain signals between the thalamus and trigeminal nerve in the brain, and reduces inflammation and pain in the trigeminal nerve. DHE has 10 times less potency than ergotamine so it is less likely to cause vascular side effects. It is difficult to predict how long its effects will last because it takes time for it to diffuse from receptors in the body.

When to interrupt dosage

The dose of D.H.E. 45 is contingent upon the diagnosed affliction. The amount of dosage likewise differs as per the delivery technique (e.g. Intramuscular; Intravenous; Subcutaneous or Spray, metered) featured in the ensuing table.

Condition

Dosage

Administration

Cluster Headache

, 1.0 mg/mL, 4.0 mg/mL, 2.5 mg, 0.5 mg/pump actuation

Intramuscular; Intravenous; Subcutaneous, , Injection, solution, Injection, solution - Intramuscular; Intravenous; Subcutaneous, Spray, Spray - Nasal, Nasal, Liquid, Liquid - Intramuscular; Intravenous; Subcutaneous, Liquid - Nasal, Tablet - Oral, Oral, Tablet, Injection - Intramuscular; Intravenous; Subcutaneous, Injection, Spray, metered, Spray, metered - Nasal

Migraine Disorders

, 1.0 mg/mL, 4.0 mg/mL, 2.5 mg, 0.5 mg/pump actuation

Intramuscular; Intravenous; Subcutaneous, , Injection, solution, Injection, solution - Intramuscular; Intravenous; Subcutaneous, Spray, Spray - Nasal, Nasal, Liquid, Liquid - Intramuscular; Intravenous; Subcutaneous, Liquid - Nasal, Tablet - Oral, Oral, Tablet, Injection - Intramuscular; Intravenous; Subcutaneous, Injection, Spray, metered, Spray, metered - Nasal

Warnings

D.H.E. 45 has nineteen contraindications, and should thus be abstained from if any of the conditions in the ensuing table are encountered.

D.H.E. 45 Contraindications

Condition

Risk Level

Notes

Coronary Vasospasm

Do Not Combine

Pulse Frequency

Do Not Combine

Pulse Frequency

Do Not Combine

Chest Pain

Do Not Combine

Pulse Frequency

Do Not Combine

Documented Silent Ischemia

Do Not Combine

Severe Hepatic Impairment

Do Not Combine

Renal Insufficiency

Do Not Combine

Migraine with Aura

Do Not Combine

Hypertensive disease

Do Not Combine

Liver Failure

Do Not Combine

Hemiplegic migraine

Do Not Combine

Vasospastic Angina

Do Not Combine

Women who are breast-feeding or pregnant

Do Not Combine

Vascular Surgery

Do Not Combine

Peripheral Arterial Disease

Do Not Combine

Pulse Frequency

Do Not Combine

Coronary Artery Disease

Do Not Combine

Severe Hypersensitivity Reactions

Do Not Combine

Dihydroergotamine may interact with Pulse Frequency

There are 20 known major drug interactions with D.H.E. 45.

Common D.H.E. 45 Drug Interactions

Drug Name

Risk Level

Description

4-Bromo-2,5-dimethoxyphenethylamine

Major

Dihydroergotamine may increase the hypertensive and vasoconstricting activities of 4-Bromo-2,5-dimethoxyphenethylamine.

4-Methoxyamphetamine

Major

Dihydroergotamine may increase the hypertensive and vasoconstricting activities of 4-Methoxyamphetamine.

5-methoxy-N,N-dimethyltryptamine

Major

Dihydroergotamine may increase the vasoconstricting activities of 5-methoxy-N,N-dimethyltryptamine.

Abediterol

Major

Dihydroergotamine may increase the hypertensive and vasoconstricting activities of Abediterol.

Abemaciclib

Major

The metabolism of Abemaciclib can be decreased when combined with Dihydroergotamine.

D.H.E. 45 Toxicity & Overdose Risk

Overdosing on ergot may lead to numbness, tingling, and pain in the extremities, difficulty breathing, fluctuations in blood pressure, mental confusion, seizures, coma, nausea, vomiting, and abdominal pain. In case of overdose, affected areas should be warmed and vasodilators administered. Contact local poison control centres for more detailed instructions on how to treat ergot overdose.

image of a doctor in a lab doing drug, clinical research

D.H.E. 45 Novel Uses: Which Conditions Have a Clinical Trial Featuring D.H.E. 45?

A total of 7 active studies are investigating the potential of D.H.E. 45 to alleviate symptoms of Cluster Headache.

Condition

Clinical Trials

Trial Phases

Migraine Disorders

1 Actively Recruiting

Not Applicable

Cluster Headache

2 Actively Recruiting

Phase 1, Phase 2

D.H.E. 45 Reviews: What are patients saying about D.H.E. 45?

5

Patient Review

5/26/2010

D.H.E. 45 for Migraine Headache

I was given this drug intravenously in the ER and it was a really terrible experience. I started to feel antsy, then sort of nervous, and then the worst thing happened: I felt like I was going to jump out of my skin. It's hard to describe but I felt like I had been given a massive dose of caffeine.

5

Patient Review

11/25/2008

D.H.E. 45 for Migraine Headache

5

Patient Review

1/10/2009

D.H.E. 45 for Migraine Headache

4.7

Patient Review

9/18/2010

D.H.E. 45 for Migraine Headache

I found this medication to be totally ineffective. I have been suffering from migraines for over 13 years, and was horrified when the doctor prescribed this old drug that has severe side effects. Even the pharmacy took two hours to get it in the hospital! If you're in pain, you need something that will actually help.

4

Patient Review

10/10/2011

D.H.E. 45 for Cluster Headache

I've been struggling with migraines for over 17 years now, and my neurologist suggested a 3-day infusion treatment. DHE was the only drug that worked for me out of everything we tried. I would highly recommend it to anyone else facing similar issues.

4

Patient Review

7/3/2010

D.H.E. 45 for Migraine Headache

DHE is the only treatment that works for me and it's amazing!

1.7

Patient Review

3/7/2011

D.H.E. 45 for Migraine Headache

I was hospitalized for four days with a debilitating migane that didn't respond to any traditional treatments. This medication finally got my pain down to a more manageable level. The only side effect I experienced was some diarrhea, which is a fair tradeoff in my opinion.

1

Patient Review

1/26/2015

D.H.E. 45 for Migraine Headache

This medication is given every 8 hours, usually in a hospital setting, for 2 to 5 days. Most people will experience gastrointestinal upset from the medication, so Reglan (metoclapromide) is also administered. However, some people have reported feeling agitated and restless after taking Reglan. I found that this regimen helped reduce the intensity of my chronic migraines.
image of drug pills surrounding a glass of water symbolizing drug consumption

Patient Q&A Section about d.h.e. 45

These questions and answers are submitted by anonymous patients, and have not been verified by our internal team.

How does DHE make you feel?

"The following are side effects that may occur when taking the medication: dizziness, drowsiness, headache, nausea, vomiting, diarrhea, flushing, increased sweating, anxiety, or skin rash."

Answered by AI

What is a DHE injection?

"D.H.E. 45 should only be used to treat an active migraine headache. Do not use it to prevent a headache if you have no symptoms and do not use it to treat a tension headache that is not typical of your usual migraine headache."

Answered by AI

How long does DHE infusion last?

"The original protocol for treating migraines called for administering a dose of 0.3-1 mg of DHE every 8 hours, along with 10 mg of metoclopramide for 2-3 days."

Answered by AI

How does DHE work for migraines?

"Dihydroergotamine is a medication that attaches to pain receptors in the brain and nerves, changing how messages are sent back and forth. This changes the perception of pain in the brain. DHE does not 'cure' headaches but it should improve how often they occur and how severe they are."

Answered by AI

Clinical Trials for D.H.E. 45

Image of The University of Texas Health Science Center at Houston in Houston, United States.

Capsaicin + Oxygen + Cold Stimuli for Headache

18+
All Sexes
Houston, TX

This study investigates molecular and physical biomarkers of headaches in order to better understand mechanisms of these diseases. There are 3 main parts: 1. Use of capsaicin (active ingredient in hot chili peppers) to trigger release of calcitonin gene related peptide - the hypothesis is that this will be different in headache subjects compared to controls (and if so might be used to predict how these patients will respond to certain medications that modulate calcitonin gene-related peptide). Subjects will be given capsaicin as a cream applied to the forehead or the inner nostril, or a hot sauce that is ingested. 2. Use of capsaicin to trigger eye watering - the hypothesis is that oxygen gas will slow down the amount of eye watering. Cluster headache patients respond very powerfully to oxygen gas but to very little else. The mechanism for oxygen is unknown but in rodents there is data that it works on the parasympathetic / lacrimal gland system. This study translates rodent data into humans in a non-invasive way to confirm the mechanism of this very effective treatment. 3. Use of ice water to trigger headaches - brain freeze causes a very short-lived but intense headache that may cause similar biomarker release as other headache disorders. This may be a useful human model for other headache disorders.

Phase 1
Waitlist Available

The University of Texas Health Science Center at Houston

Mark Burish, MD PhD