Atzumi (Dihydroergotamine) for Migraine

Atzumi (dihydroergotamine) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat migraine attacks with or without aura in adults.

How Atzumi Works and How It’s Taken

Atzumi is a type of medication called an ergot medicine. It works by targeting serotonin receptors called 5-HT1D receptors. It is thought to help treat migraine by activating these receptors.

Doctors prescribe Atzumi when adults have migraine attacks with or without aura. By targeting this pathway, the medication may help manage migraine attacks.

Atzumi is given as a nasal powder, typically taken when a migraine attack starts. If needed, a second dose may be taken at least one hour later.

Typical Dosing for Migraine

The recommended dose of Atzumi for migraine is 5.2 milligrams, given into one nostril as a powdered medicine. If your headache comes back after the first complete dose or you only get some relief from your headache, you can use a second dose one hour after the first complete dose. Use a new Atzumi nasal powder device for the second dose, if needed.

Do not take more than two doses of Atzumi within a 24-hour period. It is not known if it is safe to take more than four doses of Atzumi in a seven-day period or 12 doses in a 30-day period.

This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Atzumi Side Effects

In clinical studies of dihydroergotamine for the acute treatment of migraine with or without aura in adults, the most common side effects occurred in about 2 percent to 26 percent of people. They include:

Rhinitis or nasal congestion (runny or stuffy nose)
Nausea
Changed or unusual taste
Application site reactions (nose irritation)
Dizziness
Vomiting
Somnolence (sleepiness)
Pharyngitis (sore throat)
Diarrhea

Serious Side Effects and Warnings

Atzumi can cause serious side effects that may require immediate medical attention. These include:

Serious blood flow problems — Ischemia or vasospasm, including peripheral ischemia, can reduce blood flow to the arms, legs, brain, or other organs if Atzumi is administered with interacting medications.
Heart attack and other serious heart problems — These can include myocardial ischemia, myocardial infarction, and dangerous heart rhythm changes.
Stroke and other serious brain blood vessel problems — Cerebrovascular events can occur.
Increased blood pressure — Blood pressure may rise during treatment.
Gastrointestinal or colonic ischemia — Reduced blood flow to the stomach or intestines can occur.
Medication overuse headache — More frequent headaches can occur from using acute migraine medicines too often.
Preterm labor — Early labor during pregnancy can occur.
Fibrotic complications — Scarlike tissue changes have been reported with long-term use.

Get medical help right away if you think you are having a serious reaction.

What To Know Before Taking Atzumi

Before starting Atzumi, a cardiovascular evaluation is recommended.

Tell your doctor if you have any allergies to dihydroergotamine or any ingredients in Atzumi. Do not take Atzumi if you are allergic to dihydroergotamine, ergot alkaloids, or any of the ingredients in Atzumi.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, and supplements.

Do not take Atzumi if you:

Are taking medicines known as strong CYP3A4 inhibitors
Have heart problems or a history of heart problems
Have uncontrolled high blood pressure
Have narrowing of blood vessels in your legs, arms, stomach, or kidneys (peripheral vascular disease)
Have sepsis
Have had vascular surgery
Have severe liver problems
Have severe kidney problems
Have used a triptan or an ergotamine-containing or ergot-type medicine in the last 24 hours
Have taken any medicines that constrict your blood vessels or raise your blood pressure

If you are pregnant, planning to become pregnant, or breastfeeding while taking Atzumi, talk with your doctor about the risks and benefits. Atzumi may cause preterm labor and should therefore be avoided during pregnancy.

Atzumi may reduce breast milk supply and pass into your breast milk. Atzumi may be harmful to your baby. Do not breastfeed your baby while taking Atzumi and for three days after you use Atzumi.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Atzumi?

In studies of dihydroergotamine, 30 percent to 61 percent of people responded at two hours with treatment, compared to 20 percent to 33 percent with placebo (an inactive treatment). At four hours, 47 percent to 70 percent of people responded with treatment, compared to 22 percent to 35 percent with placebo. In these studies, “response” meant migraine pain improved from moderate or severe to mild or no pain.

How long does Atzumi take to work for migraine?

After Atzumi is used, the highest blood levels are reached in about 30 minutes on average. In migraine studies, headache response was observed at two hours and at four hours after treatment.

Can Atzumi cause a stuffy nose or other nose-related side effects when used for migraine?

Yes. In a study where people used Atzumi for up to 12 months, 29 percent had irritation in or around the nose after using the medicine. Common symptoms included nose discomfort, changes in taste, stuffy nose, sore throat and nasal irritation, runny nose, cough, nose pain, nosebleeds, sneezing, itchy nose, and watery eyes.

Can Atzumi be used with other medicines for migraine?

Atzumi should not be taken within 24 hours of triptans or other ergotamine-containing or ergot-type medicines. It also should not be used with strong CYP3A4 inhibitors, and it is contraindicated with peripheral or central vasoconstrictors because of the risk of serious blood vessel problems or increased blood pressure. Talk to your doctor before taking any other medication.