Dihydroergotamine Plus Nonpharmacological Care in Children With Migraine

Children treated with a combination of outpatient dihydroergotamine infusion and multidisciplinary nonpharmacological care missed fewer days of school per month during therapy.

The combination of outpatient dihydroergotamine infusion for up to 5 days with multidisciplinary nonpharmacological care is associated with noticeable 3-month improvements in headaches and functioning in children and adolescents with migraine, a study published in Headache suggests.

The study was a retrospective chart review of patients between the ages of 11 and 18 years who received an outpatient pilot treatment in a neurology clinic (n=36). During the treatment, participants received up to 5 days of intravenous dihydroergotamine, administered using weight-based dosing up to 1 mg/mL twice daily. Adjunctive nonpharmacological care, including pain coping skills training, massage, aromatherapy, and school reintegration support, was also provided during the treatment program. The investigators evaluated changes in headache, healthcare use, and functional limitations at 3 months.

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During the 3-month treatment period, the overall mean intensity of headache declined (from 5.8±2.5 to 2.4±2.7; P <.0001). Through 3-month follow-up, the frequency of headaches decreased by a mean of 1.5 days per week (6.7±1.0 vs 5.2±2.7; P =.012). There was a 27% reduction in the proportion of children and adolescents who reported continuous headache (P =.009). Participants also had a reduction in the number of school days missed per month during therapy (median [25th-75th percentile], 4.5 [0-21.0.0] vs 0 [0.0-0.5]). Reductions in headache-related visits per month to the emergency department were also reported during the 3-month treatment period. Although many participants reported adverse effects of therapy, particularly during the first 2 days of the program, events were minor and often resolved.

Limitations of the study include the lack of a control group and the retrospective design, as well as the small sample size.

The researchers wrote that their preliminary findings suggest “treatment with [dihydroergotamine] in an outpatient setting for youth with refractory primary headache may yield results similar to inpatient findings, while having the potential for cost savings to the family and healthcare system.”


Connelly M, Sekhon S, Stephens D, Boorigie M, Bickel J. Enhancing outpatient dihydroergotamine infusion with interdisciplinary care to treat refractory pediatric migraine: preliminary outcomes from the comprehensive aggressive migraine protocol (“CAMP”) [published online October 18, 2019]. Headache. doi:10.1111/head.13685