New Jersey Medical School - Neurosciences, Bayonne, NJ 07002, USA.
Headache. 2010 May;50(5):852-60. doi: 10.1111/j.1526-4610.2010.01622.x. Epub 2010 Jan 28.
Established consecutive-day inpatient intravenous dihydroergotamine protocols administered by bolus intravenous injection or continuous infusion injection in the hospital have demonstrated efficacy and safety in modifying the course of daily intractable headache. We conducted a study to determine efficacy, tolerability, and feasibility to treat patients with daily intractable headache with continuous intravenous dihydroergotamine in an outpatient home-based setting.
A total of 31 patients fulfilling ICHD-II criteria for chronic daily headache, 25 with chronic migraine and 6 with medication overuse headache, were treated with outpatient home-based continuous intravenous dihydroergotamine for 3 days. Patients were pretreated with 10 mg intravenous metoclopramide prior to the first day of infusion and administered 3 mg dihydroergotamine given continuously at a rate of 42 mL/hour on day 1 and 2, and administered 1.5 mg on day 3 at the rate of 21 mL/hour. The primary end point was a change in pain intensity, as measured by an 11-point numeric pain intensity scale at the end of 3 days. The secondary end point was reduction in headache frequency at long-term follow-up.
Patients reported an average of 63.4% reduction in the intensity of migraine pain by the end of the 3-day infusion. Side effects were minimal and no serious adverse effects occurred. Approximately one-third of patients became completely headache-free after day 3, and 1 patient had no improvement. Long-term follow-up data indicated an average 86% reduction in headache frequency and almost every patient converted from chronic daily headache to episodic migraine except for 1 patient. Patients with medication overuse headache were no longer consuming the daily offending medication.
Efficacy and safety of our outpatient home-based intravenous dihydroergotamine program compared favorably to that of established inpatient intravenous pulse injection and continuous infusion protocols for the treatment of intractable migraine. The use of outpatient continuous intravenous dihydroergotamine is an effective and well-tolerated therapy for intractable migraine but without the added cost and inconvenience of hospitalization.
已确立的连续日内住院静脉二氢麦角胺方案，通过静脉推注或连续输注注射，已在改变每日难治性头痛的病程方面显示出疗效和安全性。我们进行了一项研究，以确定在门诊家庭环境中使用连续静脉二氢麦角胺治疗每日难治性头痛的疗效、耐受性和可行性。
共有 31 名符合 ICHD-II 慢性每日头痛标准的患者，25 名慢性偏头痛患者和 6 名药物过度使用性头痛患者，接受门诊家庭连续静脉二氢麦角胺治疗 3 天。患者在第一天输注前预先给予 10mg 静脉甲氧氯普胺，并在第 1 天和第 2 天以 42mL/h 的速度连续给予 3mg 二氢麦角胺，第 3 天以 21mL/h 的速度给予 1.5mg。主要终点是通过第 3 天结束时的 11 点数字疼痛强度量表测量的疼痛强度变化。次要终点是长期随访时头痛频率的降低。
患者报告在 3 天输注结束时偏头痛疼痛强度平均降低 63.4%。副作用最小，没有发生严重不良反应。大约三分之一的患者在第 3 天后完全无头痛，1 名患者无改善。长期随访数据显示头痛频率平均降低 86%，除 1 名患者外，几乎所有患者均从慢性每日头痛转为发作性偏头痛。药物过度使用性头痛患者不再每天服用引起头痛的药物。
与既定的住院静脉脉冲注射和连续输注方案相比，我们的门诊家庭静脉二氢麦角胺方案的疗效和安全性相当，可有效治疗难治性偏头痛。门诊连续静脉二氢麦角胺的使用是一种有效且耐受性良好的难治性偏头痛治疗方法，但没有住院治疗的额外费用和不便。
