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Migranal (Dihydroergotamine Mesylate)
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Migranal (Dihydroergotamine Mesylate) is a prescription medication indicated for the acute treatment of migraine headaches with or without aura. It belongs to a class of drugs known as ergot alkaloids, which work by constricting blood vessels in the brain to alleviate migraine symptoms.
Migranal acts on serotonin receptors and adrenergic receptors in the brain, leading to vasoconstriction and decreased inflammation associated with migraines. By narrowing blood vessels and reducing inflammation, Migranal helps to alleviate migraine symptoms such as headache pain, nausea, and sensitivity to light and sound.

Precautions and Warnings with Migranal
- Pregnancy and Nursing: Use of Migranal during pregnancy or breastfeeding should be avoided unless the potential benefits outweigh the risks to the fetus or infant.
- Pediatric Use: Safety and efficacy of Migranal have not been established in pediatric patients.
- Elderly Patients: Caution should be exercised when prescribing Migranal to elderly patients, who may be more susceptible to adverse effects.
- Not for Prophylactic Use: Migranal is not intended for the prevention of migraines. It is specifically indicated for the acute treatment of migraine attacks.
- Cardiovascular Risks: Migranal may increase the risk of cardiovascular events, particularly in patients with pre-existing cardiovascular conditions or risk factors.
- Peripheral Ischemia: Use caution in patients with peripheral vascular disease as Migranal may cause peripheral ischemia.
- Uncontrolled Hypertension: Patients with uncontrolled hypertension should not use Migranal due to its potential to increase blood pressure.

Migranal Side Effects
While Migranal is generally well-tolerated, like any medication, it may cause side effects in some individuals. Side effects associated with Migranal may include:
Common Side Effects
- Pain, bruising, swelling, or irritation where the medicine was applied
- Drowsiness
- Dizziness
- Nausea, vomiting, diarrhea
- Runny nose
- Altered sense of taste
- Sore throat
Serious Side Effects
- Numbness, cold feeling, or pale appearance of your fingers or toes
- Sudden or severe stomach pain, weight loss, nausea, vomiting, constipation, bloody diarrhea, fever
- Severe headache, blurred vision, pounding in your neck or ears
- Burning sensation in the nose, mouth, throat, and altered sense of taste
- Fast or slow heart rate
- Swelling or itching
- Signs of a Blood Clot: Sudden numbness or weakness on one side of the body, chest pain, problems with vision or speech, pain or swelling in one leg
- Heart Attack Symptoms: Chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating.

Drug Interactions with Migranal
Migranal may interact with other medications, supplements, or substances, potentially affecting its effectiveness or increasing the risk of adverse effects. Some notable interactions with Migranal may include:
- Alpha-/beta-agonists (e.g., Epinephrine, pseudoephedrine)
- Amoxapine
- Antifungal agents (e.g., Ketoconazole, itraconazole)
- Aprepitant
- Beta-blockers (e.g., Atenolol, metoprolol, propranolol, sotalol)
- Bromocriptine
- Cobicistat (found in Evotaz)
- Conivaptan
- Diltiazem
- Doxepin
- Dronedarone
- Grapefruit juice
- HIV protease inhibitors (e.g., Ritonavir, nelfinavir, indinavir)
- Letermovir
- Linezolid
- Lithium
- Macrolide antibiotics (e.g., Erythromycin, clarithromycin, troleandomycin)
- Mifepristone
- Mirtazapine
- Monoamine oxidase inhibitors (e.g., Moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
- Narcotic pain relievers (e.g., Fentanyl, meperidine, tramadol)
- Nicotine
- Nitroglycerin
- Other ergot medications (e.g., Methysergide, ergonovine, ergoloid mesylates)
- Protein kinase inhibitors (e.g., Crizotinib, imatinib, ribociclib)
- Selective serotonin reuptake inhibitors (e.g., Citalopram, escitalopram, fluoxetine)
- Serotonin/norepinephrine reuptake inhibitors (e.g., Desvenlafaxine, duloxetine, venlafaxine)
- Trazodone
- Tricyclic antidepressants (e.g. Amitriptyline, imipramine)
- “Triptan” migraine medications (e.g., Eletriptan, rizatriptan, sumatriptan)
- Tryptophan
- Verapamil
- Vilazodone

Strengths and Dosages of Migranal
Your strength and dosage of Migranal will be based on your prescriber recommendations. Always follow the guidelines of your doctor or nurse with any prescription medication.
Available Strengths
Each unit-dose spray delivers 0.5 mg of dihydroergotamine mesylate.
Recommended Dosages
For the acute treatment of migraine headaches, the recommended dosage of Migranal Nasal Spray is one spray (0.5 mg) administered into one nostril. If migraine symptoms persist or recur, a second dose may be administered after 15 minutes, not exceeding a total of two doses in any 24-hour period.

Cost of Migranal in the USA
At this time of writing, the cost for Migranal nasal spray (4 mg/mL) to be approximately $4,035 for a supply of 8 milliliters.
Patients are encouraged to check with their local pharmacies, insurance providers, or explore patient assistance programs to determine the most cost-effective option for obtaining Migranal.
Why Is Migranal So Expensive?
- Research and Development: The development of Migranal involved extensive research and clinical trials to establish its safety and efficacy for various indications. The costs associated with research and development are often reflected in the price of the medication.
- Manufacturing Costs: Manufacturing pharmaceutical products like Migranal involves complex processes and quality control measures, which contribute to the overall cost of production.
- Marketing and Distribution: Pharmaceutical companies invest significant resources in marketing and distributing their products to healthcare providers and patients, which can contribute to the overall cost of the medication.
- Patent Protection: Migranal may be protected by patents that prevent generic competition, allowing the manufacturer to set higher prices for the medication until the patents expire.

Migranal Alternatives
While Migranal is commonly prescribed for the acute treatment of migraine headaches, there are alternative treatments available for individuals who may not respond well to Migranal or prefer different treatment options. Some alternatives to Migranal include:
Other Triptans
- Sumatriptan (Imitrex)
- Rizatriptan (Maxalt)
- Eletriptan (Relpax)
- Zolmitriptan
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve)
- Aspirin (Bayer, Excedrin Migraine)
- Ketorolac (Toradol)
Antiemetics

FAQs About Migranal
How quickly does Migranal work?
Migranal typically starts to work within 15 to 30 minutes after administration.
Can I use Migranal for every migraine attack?
Migranal is intended for the acute treatment of migraine attacks and should not be used for prophylaxis.
What should I do if Migranal does not relieve my migraine symptoms?
If Migranal does not provide relief from your migraine symptoms, contact your healthcare provider for further evaluation and alternative treatment options.
Can I drive or operate machinery after using Migranal?
Migranal may cause dizziness or drowsiness in some individuals. Avoid driving or operating machinery until you know how Migranal affects you.
Are there any dietary restrictions while using Migranal?
There are no specific dietary restrictions associated with the use of Migranal. However, it is important to maintain a healthy diet and stay hydrated, especially during migraine attacks.
Can I take other medications with Migranal?
It is important to inform your healthcare provider about all medications, including prescription, over-the-counter, and herbal supplements, before using Migranal to avoid potential drug interactions.
How should Migranal be stored?
Migranal Nasal Spray should be stored at room temperature away from light and moisture. Do not freeze. Keep out of reach of children.
Is Migranal addictive or habit-forming?
Migranal is not considered addictive or habit-forming when used as directed for the treatment of migraine headaches.
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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.