Rescue medications are taken to relieve symptoms of acute (active, ongoing) migraine attacks. Dihydroergotamine (DHE) is a rescue medication that’s often administered in emergency rooms, urgent care centers, and infusion clinics.

Migraine is considered to be the second leading cause of disability in the United States. Keep reading to learn how DHE works to provide relief for debilitating migraine symptoms like a throbbing headache, nausea, and severe sensitivity to light, sound, and odor.

What Is DHE?

DHE belongs to a category of medications called ergot alkaloids. Ergot alkaloids have been used to treat migraine since 1925 and are made from rye fungus. DHE isn’t as widely used for migraine headaches today, but it’s still recommended when triptans stop working or other first-line treatments don’t reduce migraine symptoms.

Unlike other classes of drugs commonly taken for migraine headaches, including nonsteroidal anti-inflammatory drugs (NSAIDs), ergot alkaloids have very little effect on the liver. They also have a very low risk of triggering a medication overuse headache. But they’re only used for the treatment of migraine headaches and cluster headaches, not other types of pain.

How Does DHE Work?

DHE and other ergot alkaloids reduce the symptoms of migraine attacks by narrowing blood vessels and reducing pain signals.

Narrowing Blood Vessels

DHE causes the blood vessels in your brain to constrict (become narrower). Researchers used to believe migraine headaches were the direct result of blood vessels expanding and narrowing in the brain, but they now think changes in blood flow aren’t likely to be the main cause. However, they believe these fluctuations might still contribute to migraine attacks in some way, so narrowing blood vessels might still be beneficial.

Reducing Pain Signals

DHE also blocks pain signals in your brain, which may help reduce the intensity of a migraine headache. DHE doesn’t work to prevent the headache from happening in the first place, but it can treat an active migraine headache during an attack.

When DHE Is Used for Migraine

DHE is only used during migraine attacks and is usually administered under direct healthcare provider supervision. It’s used on an as-needed basis only, so you won’t take it regularly for migraine management. Your doctor might suggest DHE if:

• Other medications, especially triptans, haven’t improved your migraine symptoms.
• Your migraine headache improves with triptans but returns within 24 hours.
• You have status migrainosus, a migraine that lasts longer than 72 hours.

You might get DHE in an emergency room or other hospital setting, but in rare cases, a healthcare provider may send it home with you with specific instructions on how to use it. In most cases, DHE is more effective when taken at the beginning of a migraine attack. You may need to take it with an antiemetic drug, a medication to manage nausea and vomiting. DHE may also be included in a migraine cocktail at an infusion center.

Forms of DHE

Unlike some other acute migraine medications, DHE isn’t usually taken orally because it isn’t absorbed well in the stomach. So DHE might be a good option if you’re unable to swallow pills. Here are the most common ways DHE is taken.

Intravenous Infusion

Intravenous (IV) infusions provide the fastest way to deliver DHE into your bloodstream. A licensed healthcare provider must administer your infusions for your safety.

Injection

DHE injections also get into your bloodstream quite quickly. You inject it into a muscle (intramuscular injection), where almost 100 percent of the medication is absorbed. A healthcare provider can inject it for you, or they may teach you to inject it on your own.

Nasal Spray

DHE nasal spray is a great alternative for people who don’t like needles or injections. Insert the tip into your nostril and press to release the nasal spray while keeping your head upright. The tissues inside your nose absorb the DHE and deliver it into your bloodstream. Not everyone can absorb medication quickly in this way, so the effectiveness varies more than with other forms.

Possible DHE Side Effects

Some people taking DHE for a migraine attack might experience side effects from the medication. Some side effects aren’t much of a concern and should go away quickly on their own. Tell your doctor if they continue for a long time or seem severe.

The most common DHE side effects are usually mild.

Dizziness

Taking DHE might make you feel dizzy or unsteady on your feet. If you feel dizzy, you may also be at risk of fainting. Be sure to stand up slowly after sitting or lying down to avoid fainting and falling. For your safety and that of those around you, avoid driving or operating heavy machinery until this side effect has worn off.

Nausea

Nausea is a common side effect of DHE, which may intensify the nausea you already experience during a migraine attack. This is why many medical providers administer DHE with an antiemetic drug, which can prevent nausea and vomiting.

Diarrhea

Diarrhea is also common with DHE use, but it’s usually short-lived. Be sure to drink plenty of water if you have diarrhea from DHE, as it increases your risk of dehydration.

Sweating

DHE can cause mild skin flushing and sweating. Most sweating is mild, but you should tell your doctor if your sweating comes with concerning heart-related symptoms like chest pain or an irregular heartbeat.

When To Call Your Doctor

Some DHE side effects may be signs of complications. Others may come from an allergic reaction. It’s important to call your doctor right away or seek emergency care if you experience signs of an allergic reaction, overdose, or adverse events. Signs can include:

• Hives
• Face, throat, or tongue swelling
• Pain or tingling in your arms or legs
• Heart rhythm changes
• Chest pain
• Feeling lightheaded
• Sudden or severe stomach pain
• Bloody diarrhea
• Low back pain
• Unexplained skin wounds

Using DHE Safely

As always, you must follow your doctor’s instructions closely when self-administering DHE. Before taking DHE in any form, tell your doctor about all medications you currently take, including nonprescription drugs and dietary supplements. Doing so can help you avoid dangerous medication interactions.

It’s also important to avoid drinking alcohol while taking DHE because alcohol can increase the risk of side effects. In rare cases, DHE can cause migraine attacks to happen more frequently. Your doctor might tell you to keep a journal of your headache days and medication use.

When To Avoid DHE

DHE isn’t the safest migraine treatment for everyone. Talk to your doctor about your health and whether you can safely take DHE to treat a migraine attack. You should not take DHE for migraine headaches if you:

• Are currently pregnant or breastfeeding
• Have high blood pressure
• Have a history of heart disease
• Have taken a triptan in the past 24 hours

Talk to Your Doctor

Talk to your doctor to learn more about DHE for migraine attacks and find out if it’s safe for you. Your doctor might suggest tests to evaluate your health before considering DHE as a migraine attack treatment option. For instance, they may recommend a blood pressure screening to check for high blood pressure. Your doctor might advise you to measure your blood pressure at home before administering DHE on your own.

Join the Conversation

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What was your experience like taking DHE for migraine? Let others know in the comments below.