Migranal (Dihydroergotamine) for Migraine

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

What Members Say

MHT logo These insights are based on 54 comments about Migranal from MyMigraineTeam members. These are the experiences of a small number of individuals and are not meant to be medical advice.

Benefits:

Using Migranal at the first sign of aura can stop a migraine early.
The nasal spray offers a noninjection option for acute migraine treatment.
It remains a go-to rescue option when over-the-counter medicines do not help.

Considerations:

Migranal may not help once a migraine is already severe or present upon waking.
Nausea, dizziness, drowsiness, fatigue, stuffy nose, and taste changes can happen as side effects.
Migranal has serious blood flow risks and important drug interaction warnings.

How Migranal Works and How It’s Taken

Migranal is a type of ergot medicine. It works by acting on serotonin receptors in the brain. In migraine, this action may help narrow certain blood vessels in the head that contribute to migraine. It may also reduce the release of chemicals from pain-sensing nerves that can cause inflammation and pain.

Doctors prescribe Migranal when an adult needs treatment for an active migraine attack, with or without aura.

Migranal is given as a nasal spray, typically at the start of a migraine attack and then again 15 minutes later if needed.

Typical Dosing for Migraine

The recommended dose of Migranal for migraine is one spray in each nostril, followed 15 minutes later by one additional spray in each nostril, for a total of four sprays or 2 milligrams.

A doctor may also advise not exceeding 3 milligrams in 24 hours or 4 milligrams in seven days, and not using Migranal every day for long-term treatment.

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

Top Advice From Members on Migranal

MHT logo These insights are based on 54 comments about Migranal from MyMigraineTeam members.

Members who use Migranal often say it works best when they take it early, especially at the first sign of aura or other migraine symptoms. They also frequently mention paying attention to side effects, reading the instructions carefully, and talking with their doctor when treatment results are a challenge.

1

Use it early when migraine symptoms start.
“If I begin to have migraine symptoms while I’m awake — dizziness, odd vision, seeing swathes of colors — then I have Migranal, a nasal spray, that will take it down pretty fast.”
2

Keep track of side effects and how you feel after using it.
“Nausea is a common side effect. Though I have never ever had any negative side effects other than the occasional stuffy sinuses.”
3

Let your doctor know if Migranal is hard to get.
“Right now I am on Migranal nasal. It took a while for my insurance to cover it, but finally did.”

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Migranal Side Effects

In clinical studies of Migranal nasal spray for the acute treatment of migraine headaches with or without aura in adults, the most common side effects occurred in about 4 percent to 26 percent of people. They include:

Rhinitis (runny or irritated nose)
Changed or unusual taste
Nasal spray site reaction, such as irritation or discomfort where the spray is used
Dizziness
Nausea
Vomiting

Serious Side Effects and Warnings

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

Severe reduced blood flow with certain drug interactions — Serious or potentially life-threatening reductions in blood flow to the brain or arms and legs can occur when Migranal is taken with strong CYP3A4 inhibitors, such as ritonavir, erythromycin, or ketoconazole.
Reduced blood flow to the heart — Myocardial ischemia, heart attack, or dangerous heart rhythm problems can cause chest pain, syncope (fainting), or a fast or irregular heartbeat.
Stroke or bleeding in the brain — These can cause sudden weakness, trouble speaking, severe headache, or vision changes.
Reduced blood flow to the arms, legs, fingers, or toes — Vasospasm or peripheral ischemia can cause numbness, tingling, pain, coldness, paleness, or bluish skin color in the digits.
Increased blood pressure — Blood pressure may rise during treatment.
Fibrosis with long-term daily use of injectable dihydroergotamine — Scarring can occur in areas such as the chest or abdomen, and Migranal should not be used as chronic daily treatment.
Preterm labor during pregnancy — Migranal may trigger early labor.

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

What To Know Before Taking Migranal

Tell your doctor if you have any allergies to dihydroergotamine or have had hypersensitivity to ergot alkaloids. Do not use Migranal if you have had hypersensitivity to ergot alkaloids.

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

Do not take Migranal if you have certain health problems. These include heart disease, problems with blood flow in the heart, such as coronary artery spasm, uncontrolled high blood pressure, or certain types of migraine called hemiplegic or basilar migraine.

Do not use Migranal if you have poor blood flow in your arms or legs, an infection called sepsis, have recently had blood vessel surgery, or have severe liver or kidney problems.

Do not take Migranal with certain medicines. These include strong CYP3A4 inhibitors, such as ritonavir, erythromycin, or ketoconazole. Do not use it within 24 hours of other migraine medicines like sumatriptan or ergot-type drugs. Also, do not use it with medicines that tighten blood vessels.

If you are pregnant, planning to become pregnant, or breastfeeding while taking Migranal, talk with your doctor about the risks and benefits. If you are pregnant or planning to become pregnant, do not use Migranal. This medicine may cause early labor.

If you are breastfeeding, do not breastfeed while using Migranal and for three days after your last dose. Talk to your doctor about how to feed your baby during this time.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Migranal?

Migranal has been studied in adults with moderate to severe migraine. In these studies, doctors looked at how many people had their migraine pain improve to mild or no pain at hour 2 and hour 4. More people who used Migranal felt better than those who took a placebo (an inactive treatment) at both time points.

People who had nausea, sensitivity to light, or sensitivity to sound also had fewer of these symptoms at hour 2 and hour 4 after using Migranal.

How long does Migranal take to work for migraine?

In clinical studies, doctors measured how many people had less pain or no pain at hour 2 and hour 4 after taking Migranal. At 2 hours, about 30 percent to 61 percent of people felt better. This means Migranal may start helping within a few hours, but the exact time can vary from person to person.

Can Migranal be used with other medicines for migraine?

Some medicines should not be used with Migranal. Do not use Migranal within 24 hours of other migraine medicines like sumatriptan, other 5-HT1 agonists, or ergot-type drugs. This also includes methysergide.

Do not use Migranal with certain medicines that affect how your body processes drugs. These include strong CYP3A4 inhibitors, such as some HIV medicines, certain antibiotics, and antifungal drugs like ketoconazole and itraconazole. Using these together can increase the risk of serious blood flow problems.