OFFICE-BASED TREATMENT OF ACUTE MIGRAINE WITH DIHYDROERGOTAMINE MESYLATE

The Regional Migraine Field Trial assessed the efficacy and safety of dihydroergotamine mesylate (D.H.E. 45(R)) for migraine in the office s etting. Patients were admitted to the study provided they met the Inte rnational Headache Society definition of migraine with or without aura . Thirty-eight neurologists enrolled 311 patients (274 women and 37 me n) between the ages of 13 and 70 years in this open-design study. Nine ty-five percent of the patients had moderate or severe headache pain a t entry, and 62% had nausea. All patients received a single intramuscu lar injection of D.H.E. 45(R) 1 mg. A second intramuscular injection o f 1 mg was given 60 minutes after the first injection, if needed. An a ntiemetic was administered concomitantly with D.H.E. 45(R), if needed. Rescue therapy was given at the investigators' discretion. Efficacy w as judged by the relief of pain, patients' ability to function, need f or a second injection, need for rescue medication, and need for an ant iemetic. At 30 and 60 minutes, 46% and 72% of patients had only mild o r no head pain, respectively. At 24 hours, 77% of all patients had mil d or no head pain. D.H.E. 45(R) also improved functional ability. At 3 0 and 60 minutes, 58% and 75% of patients had only mild or no disabili ty, respectively. At 24 hours, 81% had mild or no impairment. Nausea w as present in 62% of patients at the outset, 40% of patients at 30 min utes, and 30% at 60 minutes. An antiemetic was given to 43% of patient s at the outset. The presence of nausea was similar whether or not pat ients received an antiemetic. Rescue medication was needed for 11% of patients, and adverse events were reported by 9%. In conclusion, D.H.E . 45(R) is effective therapy for acute migraine. A second dose provide s additional relief, if needed.