Please log in

Welcome to the DHE 45 Forum

Can taking DHE (dihydroergotamine mesylate) shots lead to rebound headaches, if used too frequently (for example, daily)? Does anyone know what the limitations are for the medication and/or any helpful web links for further information?

Yes. DHE needs to be limited to no more than two or three days a week to avoid rebound headaches, aka medication overuse headache (MOH). Also, contrary to what was previously thought, alternating medications will not keep us from getting into MOH. We need to limit the total days a week that we treat with abortives or pain meds to no more than two or three days a week. This might help — Help! How Can I Not Overuse Migraine Medications? at http://migraine.com/blog/living-with-migraine/help-how-can-i-not-overuse-migraine-medications/

Teri

Hi! I am migraine w/o aura intractable migraine (new diagnosis on the doc’s sheet)….anyhow, I use DHE45 and I also inject Toradol IM. My neuro believes out of all the meds out there dhe45 is the one of the least meds that will give you rebound but yes to only use it 2/3 times week. Sometimes when I am having a migraine that just will not stop, over 48-72 hours or more, he will tell me to use the DHE45 Protocol. That’s DHE45 every 8hours (3xday)for 5 days straight. I would never do that on my own, only under doctor’s orders. Alot of doctors might put you in the hospital for that and do it with IV meds.
jackie

During one of my many hospital inpatient stays, my doctor tried the DHE treatment… hoping to break it as I was in and out of the ER several times a week and admitted half of those times for a week at a time. He used DHE 9 doses the first time, tried some other things with it including keeping my vomitting and nausea under control (which is one of my biggest problems with my daily chronic migraines– I get sick over and over. I was discharged and it was unsuccessful. When I was back in the ER and admitted a few days later he gave me two more rounds of 9 doses each. I got a total of 27 doses very, very close together. He said that was the highest dose and amount of DHE he had ever seen in his many years of practicing neurology. I never did respond to it and they decided it was best to not keep going through that.

I was also hospitalized for a week 11/17/09-11/24/09 by a consulting neurologist(she’s on the board of AHS) who normally does the dhe45 by IV plus the anti-nausea to stop a bad round of migraines. Well at the time I was taking dhe45 everyday and she felt I was in rebound from that. So, she gave me a script of percocet 10/325 until a room opened up on the neurology wing. Went thru that pretty quick!! My treatment in the hospital was IV Toradol every 6hrs along with 50mg Thorazine and 75mg Benadryl plus all my regular meds. Her goal was to keep me there until I had no headache whatsoever. Never happened. By the 24th, we talked about Lidocaine drip which is done down in Pittsburgh at the clinic down there but our hospital’s neuro wing wasn’t set up for it and I’d have to go to ICU. We decided that would be a little too much and I was anxious to get home; Thanksgiving and all. So, she upped my Topamax and gave me instructions to keep upping it and also gave me a script for the Toradol in a pill, which my neuro turned over into an injectable form because you can only have so much of that per month because you’ll kill your kidneys and it ain’t no miracle drug, just might take the edge off a touch. I never go thru my 10 vials. As of last year I am on SSD because of these chronic migraine/intractable migraine they are a biatch aren’t they? I had gotten to the point of not being able to work without taking narcotics! Now isn’t that silly? I have no narcotics now and I’m going into a pain management program. I’m anxious to see how that works out.
Good luck to you-
jackie

Yes, the torodol does nothing for my headaches, I had it in pill form and in my many ER and admissions to the hospital, they would give it to me but it did nothing to help the headache, not even take the edge off. In fact, as crazy as this sounds, when I got it IV form I swear as soon as it was pushed through IV almost instantly the pain increased sharply. It sounds insane because I know it’s a popular pain killer for migraines. I know what you mean about narcotics, as those are the only thing that will even take the edge of my migraines. I was on VERY strong IV narcotics in the hospital, which scares me, because I am so young, I have never felt as though I was addicted but the doctors all worry because of my age I could become addicted. When your in THAT much pain, OF COURSE you want the only thing that you have success in taking the edge off of your migraine, so of course I would ask for it then, but when I’m migraine free I have no interest in the stuff. Currently, at home I am also prescribed Percocet 10/325 and a steroid called Decadron, along with anti-nausea pills and suppositories when I can’t keep the pill form down to try and keep me out of the hospital. I wish for you as well that you find some relief!

So, I am gathering from the above comments that DHE 45 isn’t so favored. I moved to TX from NC. Went to see a pain management clinic in Dallas. After 10minutes with the doctor he told me that he wanted me to do the inpatient treatment which was a week long. No comments about my current medications/preventatives etc. I went to them because I hadn’t had an appointment for 6months & my migraines are really popping through all of a sudden. Just thinking that they needed to be adjusted or changed; I am so frustrated about the whole situation. Tempted to fly back to NC

Kate, there are no medications without a downside. Anything with the potential to help us also has the potential to harm us. The trick is finding a balance between the two extremes.

It is possible that your pain management specialist is trying to break your cycle before addressing anything else. This can be very important. That said, a pain management specialist is rarely as well equipped as a headaches specialist to treat your Migraines. Can you get in to see one to help you soon?

Ok, thanks for the helpful info everyone. I just finished my first round of DHE IV therapy at the outpatient clinic over the weekend. Went in twice a day and within 12 hours of the final dose my migraine was back. And it hit like a ton of bricks. At the ER last night they gave me another round, and within about 6 hours my migraine started coming back. The Toradal takes some of the edge off. So now what? I can’t take my regular Axert becausee the DHE is in my system….I”m screwed! What have others done in this situations?

WRENSONG –

How are you doing today? I’m so sorry you haven’t had the result you were hoping for…. yet. I do know that this therapy can take some time to work to break a bad attack. That said, DHE can also cause rebound issues, and I can’t help but wonder if this might be what is happening to you. What is your doctor telling you at this point?

Has your doctor discussed the use of steroids to help break your attack? What about changing your anti-nausea drug to one that may be more effective in helping abort the Migraine attack? Have they tried Benadryl? Magnesium? I’m grasping at straws hon, but you do need to know that there are options out there…

If DHE causes rebound then why would my doctor prescribe it to break a rebound headache that is already happening?

lhaber4 – Just because DHE CAN cause rebound, doesn’t necessarily mean it will. Also, it is usually only a problem when taken too often. This leads to MOH (Medication Overuse Headache) which you can read about here: http://bit.ly/ijgOEO