What is Migranal (Dihydroergotamine)?

Dihydroergotamine is in a group of drugs called ergot alkaloids (ER-got AL-ka-loids). It works by narrowing the blood vessels around the brain.
Dihydroergotamine nasal is used to a treat migraine headache attack.
This medication will only treat a migraine headache that has already begun. It will not prevent headaches or reduce the number of attacks.
Dihydroergotamine nasal should not be used to treat common tension headaches or any headache that seems to be different from your usual migraine headaches.
Dihydroergotamine nasal may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Migranal (Dihydroergotamine)?

This medication can harm an unborn baby or a nursing baby. Do not use dihydroergotamine nasal if you are pregnant or breast-feeding.
Do not use this medication if you are allergic to dihydroergotamine or other ergot medicines, or if you have a history of heart disease, angina (chest pain), blood circulation problems, history of a heart attack or stroke, coronary artery disease, uncontrolled high blood pressure, severe liver or kidney disease, a serious infection, if you have recently had heart or blood vessel surgery.
Using certain medications together with dihydroergotamine can cause severe decreases in blood flow and lead to dangerous side effects. Tell your doctor about all other medications you are using, especially antibiotics, antidepressants, heart or blood pressure medications, or medicines to treat HIV or AIDS.
Also tell your doctor about all of your medical conditions, especially breathing problems, high blood pressure, ischemic bowel disease, liver or kidney disease, or risk factors for coronary artery disease (such as diabetes, menopause, smoking, being overweight, having high blood pressure or high cholesterol, having a family history of coronary artery disease, being older than 40 and a man, or being a woman who has had a hysterectomy).

What should I discuss with my healthcare provider before taking Migranal (Dihydroergotamine)?

Do not use this medication if you are allergic to dihydroergotamine or other ergot medicine such as ergotamine (Ergomar, Ergostat, Cafergot, Ercaf, Wigraine), ergonovine (Ergotrate), methylergonovine (Methergine), or methysergide (Sansert).
Do not use dihydroergotamine nasal if you are pregnant or breast-feeding, or if you have:

• a history of heart disease, angina (chest pain), blood circulation problems, coronary artery disease (hardening of the arteries), or history of a heart attack or stroke
• uncontrolled high blood pressure
• severe liver or kidney disease
• a serious infection called sepsis; or
• if you have recently had heart or blood vessel surgery (such as bypass surgery)

Using certain medications together with dihydroergotamine can cause even greater decreases in blood flow than dihydroergotamine used alone. A severe decrease in blood flow to the brain and other parts of the body can lead to dangerous side effects. Do not use dihydroergotamine if you are also using any of the following medications:

• conivaptan (Vaprisol)
• diclofenac (Arthrotec, Cataflam, Voltaren, Flector Patch, Solareze)
• imatinib (Gleevec)
• isoniazid (for treating tuberculosis)
• an antibiotic such as clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), telithromycin (Ketek), or troleandomycin (Tao)
• an antifungal medication such as clotrimazole (Mycelex Troche), itraconazole (Sporanox), ketoconazole (Nizoral), or voriconazole (Vfend)
• an antidepressant such as nefazodone
• heart or blood pressure medication such as diltiazem (Cardizem, Dilacor, Tiazac), nicardipine (Cardene), quinidine (Quinaglute, Quinidex, Quin-Release), or verapamil (Calan, Covera, Isoptin, Verelan); or
• HIV/AIDS medicine such as amprenavir (Agenerase), atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Invirase, Fortovase), or ritonavir (Norvir)

If you have certain conditions, you may need a dose adjustment or special tests to safely use this medication. Before using dihydroergotamine, tell your doctor if you have:

• breathing problems
• high blood pressure
• ischemic bowel disease
• liver disease
• kidney disease; or
• coronary artery disease (or risk factors that include diabetes, menopause, smoking, being overweight, having high blood pressure or high cholesterol, having a family history of coronary artery disease, being older than 40 and a man, or being a woman who has had a hysterectomy)

FDA pregnancy category X. This medication can cause birth defects. Do not use dihydroergotamine if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.
Dihydroergotamine passes into breast milk and may be harmful to a nursing infant. Dihydroergotamine may also decrease milk production. Do not use dihydroergotamine if you are breast-feeding a baby.

Migranal Side Effects

What are the possible side effects of Migranal (Dihydroergotamine)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Stop using dihydroergotamine and call your doctor at once if you have a serious side effect such as:

• fast or slow heart rate
• chest pain or heavy feeling, pain spreading to the arm or shoulder, and nausea, sweating, or general ill feeling
• sudden numbness or weakness, sudden headache, confusion, or problems with vision, speech, or balance
• muscle pain in your arms or legs, leg weakness
• numbness or tingling and a pale or blue-colored appearance in your fingers or toes
• swelling or itching in any part of your body
• stomach cramps, diarrhea that may be bloody
• cough with stabbing chest pain and trouble breathing; or
• dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure)

Less serious side effects may include:

• pain, soreness, burning, tingling, or dryness in your nose or throat
• runny or stuffy nose, nosebleeds
• changes in your sense of taste
• headache, dizziness, drowsiness
• feeling anxious or depressed
• cold sweats; or
• nausea, vomiting

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Migranal Interactions

What other drugs affect Migranal (Dihydroergotamine)?

Many drugs can interact with dihydroergotamine. Below is just a partial list. Talk with your doctor before using dihydroergotamine nasal if you are also taking:

• zileuton (Zyflo)
• cold or allergy medications
• nicotine (Nicoderm, Nicorette)
• diet pills, stimulants, or medication to treat ADHD (such as Ritalin or Adderall)
• an antidepressant such as fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), nefazodone (Serzone), paroxetine (Paxil), sertraline (Zoloft), and others; or
• heart or blood pressure medication such as atenolol (Tenormin), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), and others

This list is not complete and there may be other drugs that can interact with dihydroergotamine. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

What should I avoid while taking Migranal (Dihydroergotamine)?

Do not use dihydroergotamine nasal within 24 hours before or after using another migraine headache medicine, including:

• another ergot medicine such as ergotamine (Ergomar, Ergostat, Cafergot, Ercaf, Wigraine), ergonovine (Ergotrate), methylergonovine (Methergine), or methysergide (Sansert); or
• almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), sumatriptan (Imitrex), rizatriptan (Maxalt, Maxalt-MLT), or zolmitriptan (Zomig)

Grapefruit and grapefruit juice may interact with dihydroergotamine nasal and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

Migranal Dosage

How should I take Migranal (Dihydroergotamine)?

Use this medication exactly as prescribed by your doctor. Never use more than your prescribed dose of dihydroergotamine nasal. Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in treating your migraine attacks. Dihydroergotamine is not for daily use.
Dihydroergotamine nasal spray is absorbed quickly through your nasal passages and is for use only in the nose. The nasal spray liquid should not be injected into the body.
Your doctor may want to give your first dose of dihydroergotamine nasal in a hospital or clinic setting to quickly treat any serious side effects that occur.
Dihydroergotamine nasal comes in a bottle (vial) with a nasal sprayer attachment. Do not open the vial and attach the sprayer until you are ready to use the medication. A new vial and sprayer should be used for each new headache episode.
Before using the medication, prime the nasal spray by pumping exactly 4 sprays into the air.
Use the first dose of dihydroergotamine as soon as you notice headache symptoms, or after an attack has already begun. Use one spray in each nostril, and after 15 minutes use a second spray in each nostril, for a total of 4 sprays.
Do not tilt your head back while you are using the nasal spray, and do not sniff through your nose during use or just after use. Throw away the vial and sprayer after you finish using it to treat one headache episode, or no longer than 8 hours after opening the vial.
If you still have migraine symptoms after using a total of 4 sprays, call your doctor before using any more. Do not use more than 6 total sprays of dihydroergotamine nasal in any 24-hour period. Do not use more than 8 total sprays of this medication over a period of 7 days
If you use dihydroergotamine nasal long-term, your doctor may want to check your heart function periodically using an electrocardiograph or ECG (sometimes called an EKG), a machine that measures electrical activity of the heart. This will help your doctor determine if it is still safe for you to use this medication. Do not miss any scheduled visits to your doctor.
Do not give this medication to anyone else, even if they have the same headache symptoms you have. Dihydroergotamine can be dangerous if it is used to treat headache in a person who has not been diagnosed by a doctor as having true migraine headaches.
Store dihydroergotamine nasal at room temperature away from moisture and heat. Do not refrigerate or freeze the nasal spray. Do not use any stored dihydroergotamine if the expiration date on the label has passed.

What happens if I overdose on Migranal (Dihydroergotamine)?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of dihydroergotamine can be fatal.
Overdose can cause stomach pain, nausea, vomiting, confusion, weak or shallow breathing, numbness and tingling or pain in your hands or feet, blue-colored fingers or toes, fainting, and seizure (convulsions).

What happens if I miss a dose of Migranal (Dihydroergotamine)?

Since dihydroergotamine is used on an as-needed basis, you are not likely to miss a dose.
Do not use more than 6 sprays of dihydroergotamine nasal per day or more than 8 sprays per week.

Migranal Dosage

How should I take Migranal (Dihydroergotamine)?

Use this medication exactly as prescribed by your doctor. Never use more than your prescribed dose of dihydroergotamine nasal. Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in treating your migraine attacks. Dihydroergotamine is not for daily use.
Dihydroergotamine nasal spray is absorbed quickly through your nasal passages and is for use only in the nose. The nasal spray liquid should not be injected into the body.
Your doctor may want to give your first dose of dihydroergotamine nasal in a hospital or clinic setting to quickly treat any serious side effects that occur.
Dihydroergotamine nasal comes in a bottle (vial) with a nasal sprayer attachment. Do not open the vial and attach the sprayer until you are ready to use the medication. A new vial and sprayer should be used for each new headache episode.
Before using the medication, prime the nasal spray by pumping exactly 4 sprays into the air.
Use the first dose of dihydroergotamine as soon as you notice headache symptoms, or after an attack has already begun. Use one spray in each nostril, and after 15 minutes use a second spray in each nostril, for a total of 4 sprays.
Do not tilt your head back while you are using the nasal spray, and do not sniff through your nose during use or just after use. Throw away the vial and sprayer after you finish using it to treat one headache episode, or no longer than 8 hours after opening the vial.
If you still have migraine symptoms after using a total of 4 sprays, call your doctor before using any more. Do not use more than 6 total sprays of dihydroergotamine nasal in any 24-hour period. Do not use more than 8 total sprays of this medication over a period of 7 days
If you use dihydroergotamine nasal long-term, your doctor may want to check your heart function periodically using an electrocardiograph or ECG (sometimes called an EKG), a machine that measures electrical activity of the heart. This will help your doctor determine if it is still safe for you to use this medication. Do not miss any scheduled visits to your doctor.
Do not give this medication to anyone else, even if they have the same headache symptoms you have. Dihydroergotamine can be dangerous if it is used to treat headache in a person who has not been diagnosed by a doctor as having true migraine headaches.
Store dihydroergotamine nasal at room temperature away from moisture and heat. Do not refrigerate or freeze the nasal spray. Do not use any stored dihydroergotamine if the expiration date on the label has passed.

What happens if I overdose on Migranal (Dihydroergotamine)?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of dihydroergotamine can be fatal.
Overdose can cause stomach pain, nausea, vomiting, confusion, weak or shallow breathing, numbness and tingling or pain in your hands or feet, blue-colored fingers or toes, fainting, and seizure (convulsions).

What happens if I miss a dose of Migranal (Dihydroergotamine)?

Since dihydroergotamine is used on an as-needed basis, you are not likely to miss a dose.
Do not use more than 6 sprays of dihydroergotamine nasal per day or more than 8 sprays per week.
Edited from everydayhealth.com