Preventing Migraines

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Ergotamine (Ergot)

Drugs containing ergotamine (commonly called ergots) constrict smooth muscles, including those in blood vessels, and are useful for migraine. They were the first anti-migraine drugs available. Ergotamine is available by prescription in the following preparations:

• Dihydroergotamine (DHE) is an ergot derivative. It is administered as a nasal spray form (Migranal) or by injection, which can be performed at home.
• Ergotamine is available as tablets taken by mouth, tablets taken under the tongue (sublingual), and rectal suppositories. Some of the tablet forms of ergotamine contain caffeine.

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Ergotamine's role since the introduction of triptans is now less certain. Only the rectal forms of ergotamine are superior to rectal triptans. Injected, oral, and nasal-spray forms are all inferior to the triptans. Ergotamine may still be helpful for patients with status migrainous or those with frequent recurring headaches.

Side Effects. Side effects of ergotamine include:

• Nausea
• Dizziness
• Tingling sensations
• Muscle cramps
• Chest or abdominal pain

The following are potentially serious problems:

• Toxicity. Ergotamine is toxic at high levels.
• Adverse effects on blood vessels. Ergot can cause persistent blood vessel contractions, which may pose a danger for people with heart disease or risk factors for heart attack or stroke.
• Internal scarring (fibrosis). Scarring can occur in the areas around the lungs, heart, or kidneys. It is often reversible if the drug is stopped.

The following patients should avoid ergots:

• Pregnant women. Ergots can cause miscarriage.
• People over age 60.
• Patients with serious, chronic health problems, particularly those with heart and circulation conditions.

Ergotamine can interact with other medications, such as antifungal drugs and some antibiotics. All ergotamine products approved by the Food and Drug Administration (FDA) contain a "black box" warning in the prescription label explaining these drug interactions. The five FDA-approved ergotamine products are:

• Migergot suppository (marketed by G and W Labs)
• Ergotamine Tartrate and Caffeine tablets (marketed by Mikart and West Ward)
• Cafergot tablets (marketed by Sandoz)
• Ergomar sublingual tablets (marketed by Rosedale Therapeutics)