Cephalalgia Reports · Published 2026-07-01 · DOI 10.1177/25158163261470348
Pubudu Amarasena, Fiona Greenwood, Peter J. Goadsby
Background: Dihydroergotamine has been used to treat headache for eighty years. We aimed to identify factors affecting the response to DHE infusion. Methods: A retrospective service evaluation was conducted using routinely collected clinical data. Successive DHE admissions ( n = 160) were collected and the response to DHE was categorized on an ordinal scale (no response, 1–49%, 50–99%, complete response) by the study team. Generalized linear modelling with ordinal logistic regression and a cumulative logit link function was employed to identify predictors of outcome. Significance level was set at P < 0.05. Results: Data from 160 hospital admissions for dihydroergotamine of 131 patients were analysed. Their median age was 47 years (IQR 35–56) and 72.5% were female. In this cohort, 82 (63%) had migraine, 11 (8%) had cluster headache, 30 (23%) had New Daily Persistent Headache (NDPH) – migraine phenotype, 5 (4%) had both migraine and cluster headache. The median DHE dose was 11.25 mg and 15 patients received more than one cycle. Of the patients, 47 with migraine (57%), 13 with CH (81%) and 10 with NDPH (33%) had a response to DHE. Compared to migraine, DHE was more effective for cluster headache (OR = 4.2, χ 2 = 4.901, df = 1, P = 0.027), but less effective for NDPH (OR = 0.4, χ 2 = 4.440, df = 1, P = 0.035). Absence of nausea was associated with a better outcome than uncontrolled nausea (OR = 5.3, χ 2 = 6.611, P = 0.010), while cramping sensations (OR = 2.3, χ 2 = 6.174, P = 0.013) and chest pain (OR = 4.1, χ 2 = 5.089, P = 0.024) predicted a better response. Conclusion: Dihydroergotamine by infusion over five days is an effective treatment for primary headache disorders. Adequate control of nausea is essential for an optimal response while cramping sensation and chest pain may predict a better outcome.
Abstract from DOAJ. Public domain (CC0 1.0).
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Amarasena, P., Greenwood, F., Goadsby, P. (2026). Effectiveness and predictors of response to intravenous dihydroergotamine in the treatment of primary headache disorders: A service evaluation. Cephalalgia Reports. https://doi.org/10.1177/25158163261470348