Migraine and Cluster Headache Medications (cont.)
Joseph Carcione Jr, DO, MBA
Francisco Talavera, PharmD, PhD
Types of drugs in this class include ergotamine (Bellergal-S, Bellamine, Cafergot, Ergostat), dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray), and methysergide (Sansert).
- How ergot alkaloids work: These drugs stimulate serotonin (a chemical needed to transmit various nerve signals to the brain), decrease inflammation, and reverse blood vessel dilation (expansion) around the brain, thereby relieving the migraine or cluster headache symptoms.
- Who should not use these medications: People with allergy to ergot alkaloids should not use them, nor should those with peripheral vascular diseases (for example, Raynaud's disease, thromboangiitis obliterans, thrombophlebitis, or severe atherosclerosis).
- Use: These drugs are available in a variety of dosage forms designed to be swallowed, inhaled, dissolved in the mouth, or injected.
- Drug or food interactions
- Do not use ergot alkaloids within 24 hours of taking triptans.
- Do not use ergot alkaloids with other agents that affect serotonin, such as fluoxetine (Prozac), paroxetine (Paxil), or St. John’s wort.
- Some drugs decrease the ability of the body to eliminate ergot alkaloids. To avoid problems, persons taking these drugs must check with their doctor or pharmacist.
- Side effects: Ergot alkaloids may decrease blood flow because of blood vessel constriction (narrowing), thereby decreasing oxygen to various tissues. Possible symptoms include chest pain, stomach pain, and/or numbness or tingling in hands or feet. Because of this risk, only a certain amount of ergot alkaloid may be taken within 24-48 hours, and these drugs must not be taken for prolonged periods (weeks or months).
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