Headache Medicine Ergot-Derivative-Containing (Oral, Parenteral, Rectal)

Overview

The term, headache medicine Ergot-Derivative-Containing, does not refer to a specific medicine but references a type of medicine which can be used to treat severe cluster headaches and migraines. Dihydroergotamine and Ergotamine, for example, are two of the most used Ergot alkaloids. When taken by the patient, Ergot-Derivative-Containing headache medicine causes the blood vessels to narrow. Also known as vasoconstriction, this process involves the contraction of the walls of the blood vessels. When this happens, the blood vessels become narrow and less blood is able to flow through them.

Although many types of headaches are caused by vasoconstriction, certain types of head pain, such as migraines and cluster headaches, can be caused by vasodilation. When the cranial blood vessels dilate, the tissue surrounding the brain can also become inflamed and this can lead to increased pain.

As many common headaches are caused by vasoconstriction, standard treatments work by prompting vasodilation to occur. As severe, throbbing headaches are generally caused by vasodilation, these standard treatments are unlikely to work and may even increase the patient's symptoms.

By prescribing headache medicine Ergot-Derivative-Containing, however, physicians can treat patients who are suffering from migraines and cluster headaches. Unlike standard headache medication, Ergot-based medicine will cause the cranial blood vessels to constrict, thus relieving the pain and inflammation associated with the condition.

In order to increase the efficacy of Ergot-based medicines, caffeine is often added to them. This increases the speed at which the medicine is absorbed by the body and allows the medicine to take effect more quickly. In addition to this, Diphenhydramine and Dimenhydrinate may be combined with Dihydroergotamine and Ergotamine as they can help to relieve the nausea and vomiting which is often associated with severe headaches. When Ergot-based medicines are combined with Diphenhydramine, Dimenhydrinate or Pentobarbital, the medicine can also have a sedative effect on the patient. As sleep can help to relieve the pain of a migraine or cluster headache, it is not uncommon for these drugs to be added to Dihydroergotamine and Ergotamine so that a combination medication can be prescribed.

Normally characterized by severe, throbbing pain, migraines and cluster headaches can cause extreme discomfort. Patients may be visibly distressed due to the level of pain they're experiencing and they may find it difficult to move during this type of headache. In addition to this, patients may experience additional symptoms, such as vision disturbances, nausea and vomiting. Due to the severity of these headaches, patients are unable to continue with their daily routine and should be treated as swiftly as possible.

Unlike other types of painkillers, Ergot-based medicines will not alleviate other types of pain. Rather than simply blocking pain signals to and from the brain, Ergot-Derivative-Containing headache medicines work on the cause of the pain, rather than just blocking the pain itself. By allowing the blood vessels to constrict and become narrower, the pain experienced by the patient should be significantly decreased and their symptoms should be relieved.

Although headache medicine Ergot-Derivative-Containing can be extremely effective in treating migraines and cluster headaches, the vast majority of patients will not require this type of medicine. Due to the range of side effects associated with Ergot-based medicines, physicians are more likely to prescribe alternative pain relievers, such as non-steroidal anti-inflammatories, aspirin and/or acetaminophen. If the patient's symptoms can be controlled via these medicines, it is unlikely that they will be treated with Ergot-based medications.

However, when the patient is not responsive to standard pain medications and when cluster headaches and/or migraines have been diagnosed, Ergot-based medicines are a viable treatment option.

Conditions Treated

  • Cluster headaches
  • Migraine headaches
  • Severe, throbbing headaches

Type Of Medicine

  • Ergot alkaloids
  • Vasoconstrictor

Side Effects

When taking medication, patients may experience some adverse effects. As some side effects are more likely to occur when patients first start taking medication, they may not require medical attention. If patients experience the following side effects when taking an Ergot-based medicine, they may diminish over time:

  • Vomiting, nausea or diarrhea (occurring without problems with blood circulation or other signs of overdose)
  • Abdominal pain
  • Drowsiness or dizziness (occurring without problems with blood circulation or other signs of overdose, especially with combinations containing Diphenhydramine, Dimenhydrinate or pentobarbital)
  • Restlessness or nervousness
  • Dryness of mouth (especially with combinations containing Belladonna Alkaloids, Dimenhydrinate or Diphenhydramine)
  • Rectal discomfort
  • Irregular bowel movements
  • Difficulty in moving bowels

Although the above side effects may not require medical intervention, patients should always seek medical help if they are concerned about the presence of adverse effects. In addition to this, patients should seek medical assistance if they experience any of the following side effects when taking an Ergot-based medicine:

  • Swelling of fingers, face, lower legs or feet
  • Absence of pulse
  • Unusual tiredness
  • Blurred vision
  • Irregular or slow heartbeat
  • Decrease in blood pressure
  • Weak, rapid pulse
  • Lightheadedness
  • Pounding in the ears
  • Fainting
  • Pain in lower back
  • Fever
  • Lower abdominal pain
  • Loss of appetite
  • General feeling of illness

Similarly, patients will need to obtain medical help if they experience the following side effects for a period of one hour or longer:

  • Tingling, numbness or coldness in face, toes or fingers
  • Weakness in legs
  • Itching of skin

As Ergot-based medicines affect blood circulation, some side effects may indicate that the patient is experiencing problems with their circulation. Due to this, patients should obtain immediate medical help if they experience the following adverse effects when taking a Ergot-derivative medicine:

  • Confusion or anxiety (severe)
  • Rise in blood pressure
  • Change in vision
  • Muscle pain
  • Chest pain
  • Pain in legs, arms or lower back, particularly if pain presents itself in heels or calves while walking
  • Convulsions or seizures
  • Bluish-colored, cold or pale feet or hands (when felt alongside other side effects listed here and not due to cold temperatures)
  • Diarrhea
  • Violet or red-colored blisters on skin of the feet or hands
  • Shortness of breath
  • Vomiting, nausea, diarrhea, severe bloating or stomach pain, occurring together with problems with blood circulation or other indications of overdose
  • Slow or fast heartbeat
  • Unusual excitement
  • Drowsiness, dizziness or severe weakness, occurring together with poor blood circulation or other signs of overdose
  • Headaches, more severe and/or more often than before
  • Problems with moving bowels, in conjunction with discomfort and/or pain in the rectum (with suppositories only)

In addition to this, patients should obtain medical advice if they experience any side effects which are not listed above when taking an Ergot-based headache medicine.

When patients stop taking an Ergot-derived medicine, it may take some time for their body to adjust and they may, therefore, continue to experience some side effects. If the patient's headache returns or worsens, patients should seek immediate medical help.

Dosage

When patients are prescribed an Ergot-based medicine, their dose will depend on the specific type of medicine they're given and their condition, as well as their medical history, age and weight.

If adult patients are prescribed Dihydroergotamine to treat a migraine or cluster headache, for example, they are normally advised to use 1mg of medication. If the pain persists and the patient isn't experiencing any side effects, another 1mg of Dihydroergotamine may be given, providing it has been at least one hour since the first dose. As Dihydroergotamine is administered via injection, patients or their caregivers will be taught how to deliver this medicine safely.

If patients are prescribed Ergotamine to relieve a migraine or cluster headache, however, they may be given the medication as a standard oral capsule or tablet. Alternatively, they may be prescribed sublingual tablets which should be held under the tongue until they dissolve. If patients are prescribed sublingual tablets, they should not attempt to chew or swallow the tablet and they should not drink, eat or smoke while the tablet is under their tongue.

Generally, adult patients are prescribed 1-2mg of Ergotamine and are advised to take a second and third dose, if their symptoms require it. However, patients should leave at least thirty minutes between each dose of medicine. In some cases, patients may be advised to take a larger initial dose of 3mg, without any subsequent doses. Ergotamine should not be taken more than twice per week, with at least five days between each use of medication.

If children are given Ergotamine to treat migraine headaches, they are usually prescribed 1mg of the medicine. A second and third dose may be given if their symptoms persist but each dose should be more than thirty minutes apart. Like adult patients, children should not be given Ergotamine more than twice per week and at least five days should occur between uses of the medicine. Although pediatric patients may be prescribed Ergotamine, this medication is not normally given to children who are under the age of six years.

As well as being used to relieve an existing headache, Ergotamine may be used to prevent cluster headaches and migraines. Adult patients may be advised to take 1-2mg of Ergotamine on a daily basis so prevent headaches, for example, and their dose may be increased to 1-2mg of Ergotamine twice or three times per day, if their symptoms persist.

In some instances, Ergotamine may be prescribed in suppository form. If so, adult patients are usually given a dose of 1-2mg, with a second or third dose to be taken if required. At least thirty minutes should be left between doses. When taking Ergotamine in suppository form, adult patients should not use more than 4mg per day. Similarly, the medicine should only be used twice per week and at least five days should be left between each application of the medicine.

If pediatric patients are prescribed Ergotamine in suppository form, they will usually be given 0.5-1mg of medicine. Pediatric patients should not be given more than 1mg of Ergotamine per day in suppository form and the medicine should not be used more than twice per week. If the medicine is used twice in one week, at least five days should be left between each use of the medicine. When prescribing medicine for pediatric patients, physicians will only normally prescribe Ergotamine if the patient is over the age of six years.

When using an Ergot-based medicine in suppository form, patients will need to insert the suppository into their rectum. If necessary, the suppository can be kept in the refrigerator and/or run under cold water to make it easier to administer. In addition to this, patients can cut the suppository into smaller pieces to ensure that they have access to the relevant dose and that it can be administered easily.

In most cases, Ergot-based medicines are more effective if the patient takes them as soon as the headache starts to develop. If patients experience warning signs before a headache or migraine, they should take their medicine as quickly as possible and not wait for the pain to start. In addition to this, patients may obtain more relief if they lie down in a dark room once they have taken their medication.

As well as prescribing an Ergot-based medicine, doctors may prescribe additional medicines for the patient. It's important that patients follow their doctor's instructions, even if they are not currently obtaining pain relief. In some cases, medications can take weeks to have a full effect. Whilst some patients may continue to experience some pain whilst using an Ergot-based medicine, their pain should be less severe than it was and their headaches should occur less frequently.

If patients do not gain any symptom relief, they should contact their physician for advice. Patients should not alter or increase their dose of medicine without obtaining medical advice. Taking too much of an Ergot-based headache medicine can cause serious side effects to occur. Similarly, if these medications are used too often, they become less effective.

If patients are unsure how to take their medication or when to take the medicine, they should seek advice from their pharmacist or their physician.

Potential Drug Interactions:

As some medicines can interact with one another, it may not be appropriate for patients to take Ergot derivatives when they are taking certain other medicines. For example, using Ergot-based medicines alongside the following medications is not recommended:

  • Atazanavir
  • Dasabuvir
  • Ranolazine
  • Boceprevir
  • Potassium
  • Cobicistat
  • Rilpivirine
  • Telaprevir
  • Riociguat
  • Darunavir
  • Ritonavir
  • Elvitegravir
  • Paritaprevir
  • Ombitasvir
  • Voriconazole

Similarly, taking Ergot-based medicines in conjunction with the following medicines is not usually recommended:

  • Acenocoumarol
  • Clorazepate
  • Alprazolam
  • Clobazam
  • Amobarbital
  • Cobimetinib
  • Anisindione
  • Chlorzoxazone
  • Aprobarbital
  • Clonazepam
  • Axitinib
  • Daclatasvir
  • Bosutinib
  • Donepezil
  • Bromazepam
  • Diazepam
  • Bromopride
  • Doxorubicin
  • Buprenorphine
  • Dihydrocodeine
  • Bupropion
  • Deferasirox
  • Butabarbital
  • Dicumarol
  • Butalbital
  • Delavirdine
  • Butorphanol
  • Calcifediol
  • Elbasvir
  • Carbinoxamine
  • Erlotinib
  • Carisoprodol
  • Estazolam
  • Chloral Hydrate
  • Hydromorphone
  • Chlordiazepoxide
  • Etravirine
  • Clarithromycin
  • Ethchlorvynol
  • Clozapine
  • Flurazepam
  • Codeine
  • Dantrolene
  • Flunitrazepam
  • Doxorubicin Hydrochloride Liposome
  • Fentanyl
  • Doxylamine
  • Midazolam
  • Dronedarone
  • Meperidine
  • Eslicarbazepine Acetate
  • Methohexital
  • Fluconazole
  • Methoxyflurane
  • Grazoprevir
  • Meprobamate
  • Sofosbuvir
  • Halazepam
  • Mephobarbital
  • Tenofovir Alafenamide
  • Hydrocodone
  • Methocarbamol
  • Ifosfamide
  • Mephenesin
  • Imatinib
  • Metaxalone
  • Piperaquine
  • Ketazolam
  • Phenprocoumon
  • Ledipasvir
  • Prazepam
  • Sonidegib
  • Phenobarbital
  • Lopinavir
  • Pentobarbital
  • Lorazepam
  • Pentazocine
  • Lormetazepam
  • Meclizine
  • Periciazine
  • Medazepam
  • Phenindione
  • Mifepristone
  • Quazepam
  • Morphine
  • Primidone
  • Tramadol
  • Morphine Sulfate Liposome
  • Pixantrone
  • Nifedipine
  • Remifentanil
  • Nimodipine
  • Saquinavir
  • Nitrazepam
  • Tapentadol
  • Olaparib
  • Teniposide
  • Orlistat
  • Temazepam
  • Oxazepam
  • Tacrolimus
  • Sufentanil
  • Oxycodone
  • Thiopental
  • Sunitinib
  • Oxymorphone
  • Triazolam
  • Peginterferon Alfa-2b
  • Tolvaptan
  • Secobarbital
  • Venetoclax
  • Simeprevir
  • Ulipristal
  • Sirolimus
  • Velpatasvir
  • Sodium Oxybate
  • Zolpidem

Although the above medicines are not usually taken in conjunction with Ergot-based medicines, doctors may prescribe both medications if they believe the benefit will outweigh any potential risks. If necessary, the patient's doctor may alter their dose of medication to try and prevent an interaction from occurring.

Patients should be aware that Ergot-based headache medicines can also interact with over-the-counter medicines, supplements, vitamins, foods and other substances. In particular, Ergot-derivatives may interact with the following:

  • Tobacco

Due to the possibility of interactions occurring, patients should tell their doctor if they are using any over-the-counter medicines, supplements, vitamins or recreational drugs before they are prescribed Ergot-based headache relief medicine. In addition to this, patients should obtain medical advice before using any new over-the-counter medicines, supplements or vitamins once they have started to use Ergot-based medicines.

Warnings

Before being prescribed any medication, patients should discuss their current conditions and their medical history with their physician. There are some conditions which may affect the use of Ergot-based medicines and these include:

  • Urinary tract blockage
  • Agoraphobia
  • Trauma from an accident (e.g. a broken leg or arm)
  • Panic attacks
  • Overactive thyroid (hyperthyroidism)
  • Stomach ulcer
  • Insomnia (difficulty sleeping)
  • Mental depression
  • Kidney disease
  • Diarrhea (may affect the use of Ergot-based medicines in suppository form)
  • Liver disease
  • Severe itching
  • Infection
  • Enlarged prostate
  • Difficulty urinating
  • Intestinal problems or intestinal blockage
  • Glaucoma
  • Blood vessel or heart disease
  • High blood pressure (hypertension)

Although these conditions will not necessarily prevent Ergot-based headache medicines from being prescribed, the patient's physician should be aware of them. If the patient has hypertension, for example, they may still be prescribed an Ergot-based medicine, providing the hypertension is being effectively controlled by medication.

Patients should also inform their doctor if they have recently undergone any surgical procedures or are due to undergo any procedures in the future. Angioplasties and other procedures involving the blood vessels are particularly relevant and should be discussed prior to Ergot derivatives being prescribed. Taking Ergot-based medicines before, during or after these procedures could increase the risk of severe side effects occurring and is not usually recommended.

When using an Ergot derivative headache medication, patients should attend regular consultations with their physician. This will enable their doctor to confirm the medicine is working appropriately and that the patient isn't suffering from any potentially harmful effects. In addition to this, patients may need to undergo regular testing to ensure that their Ergot-based medicine is not having a negative impact on their blood circulation.

Although Ergotamine and Dihydroergotamine may be prescribed to patients over the age of six years, these medications can cause serious side effects in patients of any age. The risks of taking Ergot-based medications should, therefore, be explained to the patient's parents, guardians or caregivers before it is prescribed.

If pediatric patients are prescribed Ergot-based medicines containing Belladonna Alkaloids, the risk of side effects may be increased. This is particularly relevant for pediatric patients who also have brain damage and/or spastic paralysis.

If pediatric patients are prescribed Diphenhydramine, Dimenhydrinate or Pentobarbital, the patient may become excited after taking the medication.

If geriatric patients are given Ergotamine or Dihydroergotamine, their risk of suffering blood circulation problems and side effects is increased. Similarly, geriatric patients may experience more side effects when taking Diphenhydramine, Dimenhydrinate, Belladonna Alkaloids or Pentobarbital.

Patients who are pregnant should not use Ergotamine or Dihydroergotamine. These medications can cause serious harm to an unborn fetus and may cause miscarriage or the death of the fetus. Due to this, pregnant patients should not be prescribed this medication.

If patients become pregnant when taking Ergotamine or Dihydroergotamine, they should contact their physician for urgent advice. If patients plan to become pregnant, they should contact their physician before attempting to conceive.

If patients breastfeed when taking Ergotamine or Dihydroergotamine, the medication may pass to the infant via the breastmilk and cause unwanted effects, such as convulsions, weak pulse, diarrhea and vomiting. In addition to this, Ergotamine or Dihydroergotamine in large amounts may decrease the flow of breast milk.

Dimenhydrinate and pentobarbital can also be transferred to an infant via breastfeeding and Dimenhydrinate, Pentobarbital, Diphenhydramine and Belladonna Alkaloids can all reduce the amount of breastmilk produced by the patient.

Many Ergot-based medicines also contain caffeine. Although this increases the effects of the medicine, caffeine can have a negative effect on infants if it is transferred to them via breastfeeding. Infants may have trouble sleeping or become jittery if caffeine is passed to them via breastmilk.

Due to this, patients are normally advised not to breastfeed whilst using Ergot-based medications. Patients should always seek medical advice before breastfeeding if they are using or have used Ergot-based headache medicines.

If the patient's medicine becomes less effective or their headaches worsen, they should contact their physician for advice. Similarly, if patients are experiencing more headaches or develop headaches within one day of taking their medication, they should obtain medical advice. This may indicate that they are becoming dependent on the medicine.

If patients use Ergot-based medicines too often or take more than the recommended dose, the medicine is likely to become less effective and the patient may develop a dependency on the medication. Due to this, the patient's symptoms may worsen and they may experience headaches more frequently. If this occurs, patients should contact their physician so that an alternative treatment plan can be put in place.

Consuming alcohol can cause or worsen headaches. Patients experiencing severe headaches are usually advised to avoid alcohol and should not consume any alcohol during the onset of a headache or whilst a headache is occurring. Patients should check with their doctor to determine whether they should remove alcohol from their diet completely.

Using nicotine replacement therapies or smoking can increase some harmful effects associated with Dihydroergotamine or Ergotamine. Due to this, patients are advised to stop smoking. In addition to this, patients should avoid using nicotine replacement products and/or smoking for several hours after taking their medication.

When taking Dihydroergotamine or Ergotamine, patients may be more sensitive to cold temperatures and blood circulation to the toes and fingers may be reduced. Patients should dress appropriately for cold weather conditions and reduce their exposure to cold temperatures. This side effect may affect geriatric patients more often, as they may have existing circulation problems.

If patients have an infection or serious illness, they may be more sensitive to the effects of Ergot-based medicines. Due to this, patients should seek medical advice before using an Ergot derivative when they are unwell.

Many Ergot-based medicines contain caffeine as it can improve the efficacy of the medication. However, caffeine can affect the results of some medical tests. If patients are due to undergo a test with Dipyridamole, for example, they should not consume any caffeine for at least twelve hours before the test. Patients should also inform the relevant healthcare practitioner that they are using an Ergot-based medicine before they are due to undergo any medical tests.

If patients are taking an Ergot derivative which contains Belladonna Alkaloids, Dimenhydrinate, Pentobarbital and/or Diphenhydramine, they may experience lightheadedness, dizziness, drowsiness and they may be less alert than they usually are. Due to this, patients should not operate machinery, drive or perform tasks which require their full attention when they have taken this medication.

Belladonna Alkaloids, Dimenhydrinate, Pentobarbital and/or Diphenhydramine also increase the effects of other central nervous system depressants. This includes alcohol, allergy medication, sedatives, tranquilizers, antihistamines, narcotics, pain medication, seizure medication, muscle relaxants, barbiturates, and/or antiemetics.

Belladonna Alkaloids, Diphenhydramine and Dimenhydrinate can cause patients to experience dryness of the throat, nose and mouth. Patients may want to use a saliva substitute, suck ice chips or chew sugarless gum and candy to obtain temporary relief from this side-effect.

Patients should be aware that Belladonna Alkaloids can have an impact on medical tests analyze the amount of acid in the patient's stomach. Due to this, patients should not use an Ergot-based medicine containing Belladonna Alkaloids for twenty-four hours before this type of test. Patients should also inform the healthcare practitioner carrying out the test that they use this type of medication.

Diphenhydramine and Dimenhydrinate can have an impact on skin tests and patients will need to seek medical advice before undergoing these types of tests. This can be particularly relevant if patients are due to undergo allergy testing. In general, medicines containing Diphenhydramine or Dimenhydrinate should not be taken for three days before the tests. Patients should also inform the healthcare professional carrying out the test that they use this medication.

Before taking an Ergot- based medicine, patients should tell their doctor if they have any existing allergies. This includes allergies to other medicines, foods, supplements, preservatives dyes and/or animals. If patients exhibit an allergic reaction when taking an Ergot-derivative headache medicine, it should be treated as a medical emergency. An allergic reaction may cause the patient to exhibit the following symptoms:

  • Wheezing
  • Difficulty swallowing
  • Difficulty breathing
  • Rash on the skin
  • Itching
  • Hoarseness
  • Hives
  • Swelling of the face, hands, lips, throat, mouth and/or tongue

As serious allergic reactions can be life-threatening, patients should obtain immediate medical help if they experience these symptoms.

Storage

When storing Ergot-based medicines at home, it is vital that patients use a secure location to keep their medication. Using a locked medicine cabinet or lockable medicine box can help to stop anyone else from accessing the medicine. It is particularly important that children and/or pets cannot gain access to this or any other medication.

In order to store Ergot-based medicines appropriately, patients should refer to their medication guide. In general, capsules and tablets can be kept at room temperature but should remain in a closed container. In addition to this, tablets and capsules should be kept away from moisture, direct light and heat. Due to this, it is not advisable to keep this type of medication in a kitchen or bathroom environment.

Often, Ergot-based medicines in suppository form will need to be kept in a cool location, such as a refrigerator. They should not, however, be frozen. As some manufacturers recommend keeping suppositories in the freezer and others do not, patients should refer to the medicine packaging in order to determine how best to store this type of medicine.

If patients are advised to stop using Ergot-based medicines or if their medication reaches its use-by date, patients will need to dispose of their medicine. However, Ergot-based medicines should never be thrown out with regular household waste as they could pose a risk to other people. Patients should contact their physician's office or pharmacist in order to access an appropriate and safe disposal service.

Summary

Although many types of headaches can be treated with standard painkillers, such as ibuprofen or acetaminophen, this isn't effective for certain types of head pain. When severe headaches are caused by vasodilation, the blood vessels need to be narrowed in order for the patient's symptoms to be relieved.

By causing vasoconstriction, Ergot-based medicines can alleviate the symptoms of severe headaches, such as migraines or cluster headaches. As these conditions can cause patients to experience extreme pain and discomfort, it's vital that they have access to effective medication.

Unlike other pain medication, Ergot-based medicines cannot be used to treat or minimize other types of pain. As they operate as vasoconstrictors, rather than pain relievers, they will only be effective if patients are suffering from head pain caused by vasodilation. Due to this, Ergot-based medication is not suitable for every patient, nor for every type of headache.

Although Ergot-based medicines do carry the risk of serious side effects, careful monitoring can ensure that patients do not suffer harmful effects when taking this type of medicine. Whilst Ergot-based medicines are not a first-choice treatment in the management of headaches, they can be extremely effective when used to treat certain types of head pain, such as cluster headaches and/or migraines.