IV dihydroergotamine (DHE) is a widely used treatment for status migrainosus or refractory chronic migraine, but there are few published studies on outcomes of this therapy.1 The report by Eller et al.2 adds to our current understanding of the effects of DHE, with a thorough description of their experience at an academic inpatient headache unit. Although the observations are retrospective, this kind of careful documentation and systematic reporting of patient experience can be enormously valuable in characterizing “real world” patient management issues. One such issue is the transient worsening of headache associated with migraine treatment, a phenomenon that occurs not only with DHE, but also not uncommonly with triptans. This intriguing response may have something to tell us about basic mechanisms of headache. From a practical standpoint, the data presented by Eller et al. tell us that transient worsening of headache with DHE does not predict a worse outcome, and is not a reason to discontinue therapy.