Safety and efficacy of ergotamine tartrate and dihydroergotamine in the treatment of migraine and status migrainosus. Working Panel of the Headache and Facial Pain Section of the American Academy of Neurology.

Abstract

The Quality Standards Subcommittee (QSS) of the American Academy of Neurology (AAN), charged with developing practice parameters for neurologists, appointed a working panel from among AAN Headache and Facial Pain Section members to review topics relevant to the clinical management of headache. The working panel elected to formulate guidelines for the use of ergotamine tartrate and dihydroergotamine (DHE). Although these medications have been used in the treatment of migraine for more than 50 years, there is uncertainty about their proper use and appropriate dosage limits. The panel designated their first project to be defining the appropriate use of ergotamine tartrate and DHE in the treatment of (1) migraine and (2) status migrainosus. This paper provides the background information for the Practice Parameter, published in this issue of Neurology (see page 585). Justification. Migraine is a very common and frequently disabling neurologic disorder. Recent estimates indicate that more than 23 million Americans currently experience migraine headache; 11 million report at least some headache-related disability [1]. About one-third of migraineurs in the United States report severe disability or the need for bed rest with their attacks [1,2]. However, the majority of migrain sufferers in the United States have never actually been diagnosed as having migraine [3], nor do they take prescription drugs [4]. Despite these patterns, headache is a leading reason for medical consultation, accounting for about 18 million outpatient visits per year in the United States. Although most headache sufferers who seek care are treated in the primary care setting [5], migraine remains a major reason for neurologic consultation. Ergotamine tartrate and DHE are leading acute treatments for migraine, but these drugs are often misused. Underutilization can needlessly prolong a migraine attack, and overutilization can produce ergotism and, in the case of ergotamine tartrate, chronic …