Dihydroergotamine (DHE) treats migraines and cluster headaches. It is an ergot alkaloid medication made from ergotamine, a naturally occurring chemical in fungus. DHE reduces migraine pulsing by constricting brain blood vessels.

When other migraine therapies fail or quick relief is needed, dihydroergotamine is usually the preferred option. The drug is available in injection solution, oral tablet, and nasal spray forms.

How Does DHE Work?

Dihydroergotamine (DHE) relieves migraines and cluster headaches by restricting brain blood vessels. The medication has numerous pharmacological effects but its mechanisms of action remain unclear. The exact mechanisms of action may differ depending on the environment and patient characteristics. Some theories proposed to explain how it works include:

  • Vasoconstriction: DHE activates alpha-adrenergic receptors in blood vessels. Activating these receptors allows for vasoconstriction of blood arteries, which lowers brain blood artery dilatation and pulsation that is responsible for migraines and cluster headaches.
  • Modulation of Serotonin Receptors: Low serotonin levels can make blood vessels dilate and cause migraine. DHE modulates serotonin receptors, particularly 5-HT1B and 5-HT1D receptors. These processes increase DHE vasoconstrictive and anti-migraine properties.
  • Inhibition of Trigeminal Nerve Activity: DHE inhibits trigeminal nerve-ending neurotransmitter release, reducing migraine discomfort and inflammation.

Dihydroergotamine Side Effects

Dihydroergotamine is an effective drug that works efficiently in treating migraines and severe headaches. However, some people may experience side effects while using this drug. It is important to be aware of these side effects for safe use of DHE.

Common Side Effects

Some of the common side effects include:

  • Dizziness
  • Anxiety
  • Mild headaches
  • Diarrhea
  • Numbness
  • Skin Rashes
  • Fever and increased Sweating

Severe Side Effects

These are rare effects but can be dangerous. Severe side effects may include:

  • Signs of Blood Clotting: Sometimes, using Dihydroergotamine may trigger symptoms related to blood clots. Even if it may not always translate to a real blood clot, it is recommended that you inform your healthcare provider, immediately after you start experiencing such symptoms as unexpected numbness and swelling in the legs.
  • Severe Headaches: Regular severe headaches may occur while on If common painkillers are not helping out, please reach out to your doctor for further advice.
  • Irregular Heartbeats: Taking Dihydroergotamine may cause slow or fast heartbeats. This may turn out to be life-threatening and should be handled as seriously as it sounds.
  • High Blood Pressure: Prolonged use of dihydroergotamine may cause high blood pressure.

Dihydroergotamine Drug Interactions

Dihydroergotamine (DHE) can interact with various drugs, causing side effects or lowering its efficacy. To avoid drug interactions, DHE users should tell their doctor about all their medications, including prescriptions, over-the-counter, herbal supplements, and vitamins.  Common medication interactions with DHE include:

  • Other Ergot Derivatives: DHE should not be used with ergotamine or methysergide due to the danger of ergot poisoning, which can cause cardiovascular problems or ergotism.
  • Triptans: Sumatriptan and rizatriptan can cause severe vasoconstriction and cardiovascular problems, hence DHE should not be administered within 24 hours of using these drugs.
  • SSRIs and SNRIs: When used with SSRIs or SNRIs, DHE may raise the risk of serotonin syndrome, a life-threatening illness that causes confusion, hallucinations, rapid heart rate, and high blood pressure.
  • Monoamine Oxidase Inhibitors (MAOIs): DHE should not be administered within 2 weeks of MAOI discontinuation because serotonin and norepinephrine buildup can cause hypertension.
  • CYP3A4 inhibitors: Antifungals like ketoconazole and itraconazole (like such Sporanox) and macrolide antibiotics like erythromycin and clarithromycin (found in Biaxin) can increase DHE levels in the blood, which may cause toxicity.
  • Beta-Blockers: Beta-blockers may increase vasoconstriction and cardiovascular risk when used with DHE.
  • Calcium Channel Blockers: These may increase DHE’s vasoconstriction and cardiovascular risks.
  • HIV Protease Inhibitors: Some may increase blood DHE levels, causing toxicity.

DHE Strengths and Dosages

Dihydroergotamine (DHE) dosages vary by formulation, condition, patient variables, symptom severity, and healthcare provider advice. The table below lists DHE strengths and doses for several formulations:

Injectable Solution1 mg/mLIntramuscular: 0.5 to 1 mg every 6 to 8 hours as needed, up to a maximum of 3 mg per day.

Intravenous: 0.5 to 1 mg every 6 to 8 hours as needed, up to a maximum of 3 mg per day.

Nasal Spray0.5 mg/mL or 4 mg/mL0.5 mg/mL: 0.5 to 1 mg (1 spray in one nostril) at the first sign of migraine headache. May repeat after 15 minutes, up to a maximum of 3 mg per day.

4 mg/mL: 1 spray (4 mg) in one nostril at the first sign of migraine headache. May repeat after 15 minutes, up to a maximum of 8 mg per day.

Oral Tablets0.5 mg or 1 mg0.5 to 1 mg (1 tablet) every 8 to 12 hours as needed, up to a maximum of 6 mg per day.


Cluster headache dosages may differ from migraine dosages. Follow the dosing recommendations on the drug package or from your doctor.

Cost of Dihydroergotamine in America

Dihydroergotamine (DHE) prices in the US vary by formulation, dosing strength, and drugstore. Individual out-of-pocket costs may reduce, depending on insurance and discounts.

Below is a breakdown of dihydroergotamine price estimation in America:

  • Injectable Solution: The average retail price for a vial of DHE injectable solution (1 mg/mL) ranges from $400 to $500, depending on the pharmacy and locale. Prices also depend on the manufacturer and generic availability.
  • Nasal Spray: DHE nasal spray costs $120 to $300 or more per unit, depending on concentration (0.5 mg/mL or 4 mg/mL), number of dosages, and other considerations. To cut costs, look for pharmacies that offer discounts or savings programs.
  • Oral Tablets: Depending on the dosage strength (0.5 mg or 1 mg) and number of tablets per box, DHE oral tablets cost differently. A packet of DHE oral tablets can cost $30 to $100 or more, depending on quantity and pharmacy pricing.

Dihydroergotamine Alternatives?

There are various migraine and cluster headache treatments besides dihydroergotamine (DHE). These alternatives include:

  • Triptans: These migraine treatments work by constricting blood arteries and blocking migraine-related neurotransmitters. Triptans include sumatriptan, rizatriptan, and zolmitriptan.
  • NSAIDs: They help relieve mild to moderate migraine symptoms. NSAIDs reduce inflammation and limit prostaglandin synthesis, which causes pain and irritation. Some common NSAIDs include ibuprofen, naproxen, and aspirin.
  • Acetaminophen: Also referred to as paracetamol, acetaminophen relieves mild to moderate migraine pain.
  • Ergotamine: Just Like DHE, ergotamine treats migraines effectively. It constricts blood arteries and blocks serotonin receptors. Most oral pills and rectal suppositories contain ergotamine.
  • Monoclonal Antibodies: Monoclonal antibodies work by targeting calcitonin gene-related peptide (CGRP), a migraine pathophysiology molecule, which can prevent frequent or severe migraines. Fremanezumab, and galcanezumab are examples of these medications.
  • Botox Injections: These are licensed to prevent chronic migraines in adults. Botox blocks pain-signalling neurotransmitters.


How often do I need to take Dihydroergotamine?

Please follow your doctor’s instructions concerning the frequency at which you should use Dihydroergotamine. However, you can take an extra dose if the headache persists. The doses should be at least 6 hours apart and should not exceed 6mLs per week.

Can I use Dihydroergotamine while pregnant?

Some migraine patients may use dihydroergotamine (DHE) in emergency treatment. However, Ergot alkaloids like DHE may cause uterine vasoconstriction, making them contraindicated in pregnancy (category X).

How do I use Dihydroergotamine?

You can take Dihydroergotamine through a simple injection under the skin, intramuscularly, or into a vein.

How long should it take for Dihydroergotamine to start working?

Typically, patients experience relief within an hour after using this medication.

IMPORTANT NOTE: The information provided here is for educational purposes only and is not intended to serve as medical advice, diagnosis, or treatment recommendations. It should not be taken as an endorsement of any specific medication or treatment. Individual health conditions and responses to treatment can vary greatly; therefore, this information should not be seen as a guarantee of safety, suitability, or effectiveness for any particular individual. Always consult with a healthcare professional for personalized medical advice and before making any decisions regarding your health or treatment plans.

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