Does Dihydroergotamine Treat the “Whole Migraine”?

Presented at the 2020 Diamond Headache Clinic Research & Educational Foundation (DHCREF) Virtual Meeting: The New Paradigm of Treatment for the Headache Patient

Authors: Sheena K. Aurora, MD, Sutapa Ray, PhD, Kelsey Satterly, PhD, Stephen B. Shrewsbury, MB ChB, John Hoekman, PhD


To review the comparative pharmacology of acute treatments for migraine.


A literature review was conducted to compare the pharmacology and biological activity of new and existing migraine specific treatments.


Comparative receptor binding of current and new migraine specific therapies is presented in tabular format. A model was created to show where in migraine progression each acute migraine specific therapeutic acts to address migraine symptoms.


Unlike other migraine therapeutics, DHE interacts with several different receptor subtypes and therefore is able to exert a greater influence over the pathophysiology of the migraine cycle (on premonitory thirst, aura, allodynia, hypersensitivity, withdrawal, ictal pain, vasoconstriction, central sensitization, postdrome and interictal period). Moreover, the slow dissociation of DHE from target receptors is thought to sustain its anti-migraine effects therefore reducing headache recurrence rates and medication overuse headaches. Achieving dose-to-dose consistency and optimal plasma concentrations of DHE has been demonstrated to maximize therapeutic gain while providing safety and tolerability in addressing acute migraine. Advances in delivery systems for DHE will address these issues.


Aurora SK, Ray S, Satterly K, Shrewsbury SB, Hoekman J, Does Dihydroergotamine Treat the “Whole Migraine”?, 2020 Diamond Headache Clinic Research & Educational Foundation (DHCREF) Virtual Meeting.