II. Indications
-
Migraine Abortive Management
- Largely replaced by Triptans
III. Contraindications
IV. Mechanism
V. Medications: Intranasal Dihydroergotamine
- Migranal Nasal Spray: 0.5 mg per spray
- Atzumi Nasal Powder Inhaler 5.2 mg/device
VI. Precautions
- Give first dose in health care facility in those with Cardiovascular Risk Factors
VII. Dosing: Adults
- Migranal
- Prepare sprayer by inserting ampule and prime pump (4 squeezes before first use)
- Use one spray each nostril
- May repeat x1 after 15 minutes (Total dose = 2mg)
- Maximum
- Day: 6 sprays (3 mg/day)
- Weekly: Twice per week or 8 sprays/week (4 mg/week)
- Atzumi Nasal Powder Inhaler
- Setup device (no priming needed)
- Spray one device into 1 nostril
- May repeat 1 spray into the same single nostril after 1 hour
- Maximum
- Day: 2 sprays (10.4 mg/day)
- Weekly: 4 dose maximum
- Monthly: 12 dose maximum
IX. Safety
- Avoid in Pregnancy (Pregnancy Category X)
- Avoid in Lactation
X. Efficacy
- Significant Migraine response in 30 minutes
- Migranal: 70%
- Placebo: 28%
- Reference
- Advantages
- Lasts longer than intranasal Imitrex
- Rebound Headache less common than Imitrex
- Rebound HeadacheIncidence: 15% within 24 hours
- Less expensive than Intranasal Imitrex ($16/dose)
- Disadvantages
XI. Resources
- Intranasal Dihydroergotamine (DailyMed)