Trudhesa (Dihydroergotamine) for Migraine

Trudhesa (dihydroergotamine) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for the acute treatment of migraine with or without aura in adults.

How Trudhesa Works and How It’s Taken

Trudhesa is a type of ergot medication that works by targeting serotonin receptors, which are sites on cells where serotonin can attach. This changes blood vessel and nerve signaling linked to migraine. In migraine, this helps reduce the processes that drive head pain and other symptoms.

Doctors prescribe Trudhesa when an adult needs treatment for a migraine attack, with or without aura, after symptoms begin.

Trudhesa is given as a nasal spray, typically at the start of a migraine attack. If needed, a second dose may be used at least one hour later.

Typical Dosing for Migraine

The recommended dose of Trudhesa for migraine is 1.45 milligrams given as two metered sprays into the nose, with one spray into each nostril. If needed, the dose may be repeated at least one hour after the first dose.

Doctors will advise not to use more than two doses within a 24-hour period or three doses within a seven-day period.

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

Trudhesa Side Effects

In clinical studies of Trudhesa 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. These side effects were reported more often with Trudhesa than with placebo (an inactive treatment).

Rhinitis (runny or stuffy nose)
Nausea
Changed or unusual taste
Application site reactions (nose irritation where the spray is used)
Dizziness
Vomiting
Somnolence (sleepiness)
Pharyngitis (sore throat)
Diarrhea

Serious Side Effects and Warnings

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

Peripheral ischemia with strong CYP3A4 inhibitors — Serious or life-threatening blood flow problems can occur when Trudhesa is taken with strong CYP3A4 inhibitors.
Serious blood flow problems — Ischemia from blood vessel narrowing (vasospasm) can include reduced blood flow to the legs and feet.
Heart problems — These can include reduced blood flow to the heart (myocardial ischemia), heart attack, and dangerous heart rhythm changes.
Stroke and other serious brain blood vessel problems — These can include cerebrovascular events, such as bleeding in or around the brain.
Increased blood pressure — Blood pressure may rise during treatment.
Fibrosis — Unusual scarring can occur, including in the chest area (pleural fibrosis) or behind the abdomen (retroperitoneal fibrosis), especially with long-term use.
Severe local irritation — Significant irritation in the nose or throat may require stopping the medication.

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

How To Save on Trudhesa

The Trudhesa website offers the Trudhesa Direct Savings Program. Eligible people with commercial medical insurance may pay as little as $0 per prescription. This offer is not available for people who use state or federal government-funded healthcare programs, such as Medicare, Medicaid, Medigap, TRICARE, Department of Defense health coverage, or Veterans Administration health coverage.

The Trudhesa Direct Savings Program also offers at-home delivery and text messages to confirm your prescription has been received, enroll in the savings program, and schedule home delivery. To learn more, visit the program website or call 800-589-0841.

What To Know Before Taking Trudhesa

Before starting Trudhesa, your doctor may recommend a cardiovascular (heart and blood vessel) evaluation.

Tell your doctor if you have any allergies to dihydroergotamine, ergot alkaloids, or any ingredients in Trudhesa.

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

Do not take Trudhesa if you:

Take a strong CYP3A4 inhibitor, such as certain HIV medications, certain antibiotics, or certain antifungal medications
Have heart disease, blood vessel spasms in the heart, uncontrolled high blood pressure, peripheral arterial disease, sepsis, severe liver problems, or severe kidney problems
Have had vascular surgery
Used a triptan or an ergot-type medication in the last 24 hours
Take medications that narrow blood vessels

Tell your doctor if you are pregnant, plan to become pregnant, are breastfeeding, or plan to breastfeed. Trudhesa should be avoided during pregnancy. Do not breastfeed during treatment and for three days after your last dose.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Trudhesa?

In studies of dihydroergotamine nasal spray for a single moderate to severe migraine attack, headache response meant pain improved to mild or no pain. At four hours, headache response ranged from 47 percent to 70 percent with dihydroergotamine nasal spray, compared with 22 percent to 35 percent with placebo in three of four studies. In one study, 61 percent had a headache response at two hours with dihydroergotamine nasal spray, compared with 23 percent with placebo.

People who had nausea, light sensitivity, or sound sensitivity at the start of treatment also had lower rates of those symptoms at two and four hours than those taking placebo.

Can Trudhesa be used with other medicines for migraine?

Some migraine medications should not be used close together with Trudhesa. Triptans, such as sumatriptan and rizatriptan, should not be taken within 24 hours of Trudhesa. Trudhesa is also contraindicated within 24 hours of other ergot-type medications, because this could lead to double medication.

Trudhesa is also contraindicated with medications that constrict blood vessels or raise blood pressure, and with strong CYP3A4 inhibitors such as ritonavir, erythromycin, clarithromycin, ketoconazole, and itraconazole.

How long does Trudhesa take to work for migraine?

The average time to the highest blood level after a dose is about 0.5 hours. In studies of dihydroergotamine nasal spray, headache response was measured at two and four hours after treatment, and some studies showed better results than placebo by two hours.