Uses

What is nasal dihydroergotamine used for?

Nasal dihydroergotamine is a medicine commonly used to treat migraine headaches, with or without aura.

Nasal dihydroergotamine may also be used for other conditions as determined by your healthcare provider.

Dihydroergotamine is also available as a different nasal spray and as an injection. See Trudhesa and Dihydroergotamine for more information.

How does nasal dihydroergotamine work (mechanism of action)?

When you have a migraine headache, the blood vessels in your brain get wider, causing pain and swelling. There are also changes in brain chemicals, such as serotonin. Nasal dihydroergotamine may work by targeting serotonin receptors in the brain, which may help shrink the blood vessels and reduce pain.

How is nasal dihydroergotamine supplied (dosage forms)?

Nasal dihydroergotamine is available as Migranal and generic nasal dihydroergotamine in a 4 mg/mL nasal spray that delivers 0.5 mg per spray.

How should I store nasal dihydroergotamine?

Dihydroergotamine nasal spray should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). Store in a cool, dry place. Keep away from heat and light. Do not refrigerate or freeze. Nasal dihydroergotamine vials must be thrown away 8 hours after opening.

Side Effects

What are the most common side effects of nasal dihydroergotamine?

The most common side effects of nasal dihydroergotamine are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

  • Runny or stuffy nose
  • Nausea, vomiting, or diarrhea
  • Change in how things taste
  • Local irritation (see below)
  • Dizziness
  • Drowsiness
  • Sore throat

There may be other side effects of nasal dihydroergotamine that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of nasal dihydroergotamine?

While less common, the most serious side effects of nasal dihydroergotamine are described below, along with what to do if they happen.

Severe Allergic Reactions. Nasal dihydroergotamine may cause allergic reactions, which can be serious. Stop using nasal dihydroergotamine and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Heart Attack, Other Heart Problems, and Stroke. Nasal dihydroergotamine can increase your risk of heart attack, other heart problems (such as an abnormal heart rhythm), or stroke, which can lead to death. Stop using nasal dihydroergotamine and get emergency help if you have any of the following symptoms.

  • Chest pain, pressure, or tightness
  • Fast or abnormal heartbeat
  • Trouble breathing
  • Pain in your back, neck, jaw, throat, or stomach
  • Unusual sweating
  • Nausea or vomiting
  • Feeling dizzy or lightheaded
  • Weakness or numbness on one side of your body
  • Loss of vision in one or both eyes
  • Sudden, severe headache with no known cause
  • Slurred speech or trouble understanding speech

Blood Flow Problems. Nasal dihydroergotamine can reduce blood flow to many areas of the body, which can be serious. Stop using nasal dihydroergotamine and tell your healthcare provider right away if you have any of the following symptoms.

  • Tingling, numbness, or change in color of fingers or toes
  • Muscle pain or weakness
  • Sudden or severe stomach pain
  • Weight loss
  • Constipation or diarrhea
  • Nausea or vomiting 
  • Fever

Increased Blood Pressure. Nasal dihydroergotamine may increase your blood pressure or make it worse if you have a history of high blood pressure. Call your healthcare provider if your blood pressure increases while using this medicine.

If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Increases in blood pressure may not be noticeable but look out for any of the following symptoms of severely high blood pressure.

  • Sudden severe headache
  • Chest pain
  • Dizziness or confusion
  • Trouble breathing
  • Nausea/vomiting
  • Blurry or other changes to vision
  • Anxiety
  • Buzzing in the ears
  • Nosebleed
  • Feeling of skipped heartbeats

Medicine Overuse Headache. Using too much nasal dihydroergotamine may cause your headaches to happen more often or get worse. This is called medicine overuse headache or rebound headache. If you notice your migraines happen daily or more frequently than before, or if they are getting worse, contact your healthcare provider.

Tissue Changes. Nasal dihydroergotamine can cause a buildup of scar tissue and inflammation around the lungs, stomach, or other organs, which is called fibrosis. This can happen in people using daily or high doses of this medicine. Do not use more medicine than is prescribed or use it daily long-term.

Local Irritation. Nasal dihydroergotamine can cause irritation to the nasal passages, which can sometimes be severe. Contact your healthcare provider if you experience any of the following symptoms that bother you.

  • Runny or stuffy nose
  • Sore throat
  • Burning feeling in your nose, mouth, and throat
  • Change in taste or smell
  • Nasal or sinus discomfort
  • Ear discomfort

Warnings & Precautions

Who should not use nasal dihydroergotamine?

Allergies to Ingredients. People who are allergic to any of the following should not use nasal dihydroergotamine.

  • Dihydroergotamine
  • Migranal
  • Any other medicine known as an ergot alkaloid
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific nasal dihydroergotamine products they stock.

Drug Interactions. Nasal dihydroergotamine should not be used while you are using certain other medicines. If you use nasal dihydroergotamine with certain other medicines, it can cause severe blood flow problems to your feet or legs. This is a serious condition called peripheral ischemia, which can lead to symptoms such as cramping, pain, tingling, weakness or heaviness in your legs or feet. It can also lead to stroke or death. Before using nasal dihydroergotamine, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Kidney Problems. Nasal dihydroergotamine should not be used if your kidneys are not working as well as they should be. If there is a concern about the health of your kidneys, your healthcare provider may do tests to determine if they are working well enough to use this medicine.

Liver Problems. Nasal dihydroergotamine should not be used if your liver is not working as well as it should be. If there is a concern about the health of your liver, your healthcare provider may do tests to determine if it is working well enough to use this medicine.

Heart Problems. Nasal dihydroergotamine should not be used if you have or have had heart problems, including chest pain (angina), a heart attack, uncontrolled high blood pressure, or coronary artery vasospasm.  Tell your healthcare provider if you have any of these problems.

Blood Vessel Problems. Nasal dihydroergotamine should not be used if you have certain problems with your arteries or veins (peripheral vascular disease) or you have had vascular surgery. Discuss these issues with your healthcare provider to help them decide if you should be using nasal dihydroergotamine.

Other Types of Headache. Not all headaches can be treated with nasal dihydroergotamine. In particular, hemiplegic and basilar headaches should not be treated with nasal dihydroergotamine. Talk with your healthcare provider if you are unsure if you have these types of headaches.

What should I know about nasal dihydroergotamine before using it?

Do not use nasal dihydroergotamine unless it has been prescribed to you by a healthcare provider. Use it as prescribed. Do not use more of this medicine than prescribed, and do not use it every day. Using it more often than prescribed may increase the risk of serious side effects.

Do not share nasal dihydroergotamine with other people, even if they have the same condition as you. It may harm them.

Keep nasal dihydroergotamine out of the reach of children. 

Nasal dihydroergotamine should not be used to prevent migraines. Nasal dihydroergotamine should be used as soon as possible once you have migraine symptoms but can be used at any point during a migraine.

Different nasal dihydroergotamine products may have different instructions for putting together the nasal pump, priming the pump before use, and how long the medicine is good for once it has been assembled. Make sure you read the instructions that come with your medicine for details. Knowing how to use nasal dihydroergotamine before you need it may be helpful when you are having a migraine headache. If you have any questions, contact your healthcare provider.

It may be helpful to keep a headache journal where you write down when you get your migraines and when you use nasal dihydroergotamine. This information could be used with your healthcare provider to determine how the medicine is working for you.

Nasal dihydroergotamine should not be injected.

What should I tell my healthcare provider before using nasal dihydroergotamine?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if nasal dihydroergotamine is right for you.

 In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

Pregnancy. Nasal dihydroergotamine may cause preterm labor and should be avoided during pregnancy. Tell your healthcare provider right away if you are or plan to become pregnant.

Breastfeeding. Do not use nasal dihydroergotamine while you are breastfeeding and for 3 days after your last dose. Nasal dihydroergotamine may pass into breast milk or reduce your breast milk supply. Tell your healthcare provider if you are breastfeeding or plan to breastfeed.

Interactions

Does nasal dihydroergotamine interact with foods or drinks?

Nasal dihydroergotamine can interact with grapefruit juice. Tell your healthcare provider if you eat grapefruit or drink grapefruit juice before using nasal dihydroergotamine.

It is unknown if drinking alcohol will affect nasal dihydroergotamine. The risk of drowsiness or dizziness may be increased if you drink alcohol while using nasal dihydroergotamine.

Does nasal dihydroergotamine interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using nasal dihydroergotamine.

  • A macrolide antibiotic, such as clarithromycin or erythromycin (Ery-Tab and others), which is a medicine used for bacterial infections
  • Ketoconazole, itraconazole (Sporanox, Tolsura), posaconazole (Noxafil), fluconazole (Diflucan), or voriconazole (Vfend), which is medicine used to treat fungal infections 
  • A protease inhibitor, such as ritonavir (Norvir) or nelfinavir (Viracept), which is a medicine commonly used to treat HIV
  • Any other ergot, such as ergotamine (Ergomar), which is medicine used to treat migraine
  • A triptan, such as sumatriptan (Imitrex and others), eletriptan (Relpax), and others, which is a medicine commonly used to treat migraines
  • A beta-blocker, such as metoprolol (Lopressor, Toprol XL, and others), atenolol (Tenormin), or propranolol (Inderal LA, Innopran XL), which is a medicine that may be used for certain heart conditions or to reduce blood pressure
  • A vasoconstrictor, such as pseudoephedrine, which is a medicine that may be used for nasal congestion and can cause blood vessels to narrow
  • A selective serotonin reuptake inhibitor (SSRI), such as fluoxetine, paroxetine, or sertraline, which is a medicine commonly used for anxiety and depression
  • Nicotine, which can be found in cigarettes, vapes, or products that help you stop smoking

Many other medicines may alter the blood levels of nasal dihydroergotamine. Tell your healthcare provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with nasal dihydroergotamine. Always check with your healthcare provider.

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Overdose/Missed Dose

What should I do if I accidentally use too much nasal dihydroergotamine?

If you or someone else has used too much nasal dihydroergotamine, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of nasal dihydroergotamine?

Nasal dihydroergotamine is meant to be used only when needed. Use it as your healthcare provider recommends. Do not use double or extra doses.

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