Dihydroergotamine, an anti-migraine drug, is not as effective as sumatriptan as a single agent for the treatment of acute migraine headache, according to results of a systematic review of published studies. However, dihydroergotamine works better when it is combined with an anti-nausea drug.

Many therapies are used in the treatment of acute migraine headache, with little agreement on effectiveness, Dr. Brain H. Rowe, of the University of Alberta, Edmonton, and colleagues explain in a report in the Annals of Emergency Medicine.

Dihydroergotamine is considered a “second-line” agent for migraine, but data on its effectiveness and tolerability are mixed.

Rowe and colleagues examined the effectiveness of dihydroergotamine in reducing pain, nausea, and relapse for episodes of acute migraine. They reviewed 11 randomized controlled studies that compared dihydroergotamine (alone or in combination with an antiemetic) with inactive placebo or any other common migraine therapy.

Results of these studies did not demonstrate a significant benefit of dihydroergotamine over other treatments. Patients on dihydroergotamine experienced nausea almost four times more often than those on the other therapies.

The evidence suggests that dihydroergotamine is “not as effective as” sumatriptan or phenothiazines as a single agent for treatment of acute migraine headache, the authors write. However, when given with an antiemetic, dihydroergotamine appears to be as effective as other commonly used anti-migraine agents, they report.

Given its nonnarcotic properties, dihydroergotamine combined with an antiemetic should be considered as effective initial therapy, they conclude.

SOURCE: Annals of Emergency Medicine, April 2005.