There is a form of ergotamine available for Injectable use under the trade name of D.H.E. 45®, and by inhalation under the trade name of Migranal®. It is useful in the acute treatment of migraine and other vascular headaches such as cluster headache. The Injectable form is usually given as intramuscular medication, but can also be given intravenously or subcutaneously. To be effective in aborting a migraine attack, it should be given as early as possible into the headache. Follow-up doses may be needed in some patients.
Injectable DHE-45® is also used for the treatment of status migraine (a prolonged and severe attack lasting for multiple days). It is given by slow intravenous injection with an anti-nausea medication and can be repeated every eight hours. Some patients may require up to nine doses. It can also be given by a continuous pump placed under the skin for 3-5 days.
Side effects include nausea and leg cramping. As with the triptans, this medication can cause vasoconstriction and therefore should not be used in patients with coronary or cerebrovascular disease. As with other ergot related compounds, it should not be used with febrile infections or with erythromycin and related antibiotics. Do not use triptans within 24 hours of DHE. Women should avoid the use of DHE if they may be pregnant as it may cause miscarriage.