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Overview: Nasal dihydroergotamine is used to treat acute migraines. It works by helping reduce pain and inflammation. Common side effects include runny or stuffy nose, nausea, change in how things taste, and nasal irritation. Serious side effects may include high blood pressure, blood flow problems, and heart problems. Tell your health care provider about all of your medical conditions and all medicines and supplements you use before using nasal dihydroergotamine. Nasal dihydroergotamine interacts with many medicines, which can lead to serious side effects.

Uses

What is nasal dihydroergotamine used for?

Nasal dihydroergotamine is a medicine commonly used to treat migraine, with or without aura.

Nasal dihydroergotamine may also be used for other conditions as determined by your health care provider.

Dihydroergotamine is also available as an injection. See Dihydroergotamine for more information.

How does nasal dihydroergotamine work (mechanism of action)?

During a migraine, it is thought that the blood vessels in the brain widen, causing pain and swelling. There may also be changes in brain chemicals, such as serotonin. Nasal dihydroergotamine may work by targeting serotonin receptors in the brain, which may help narrow the blood vessels and reduce pain and inflammation.

How is nasal dihydroergotamine supplied (dosage forms)?

Brands and other names

  • Migranal

Dosage forms and strengths

  • 4 mg/mL nasal spray that delivers 0.5 mg per spray

How should I store nasal dihydroergotamine?

Dihydroergotamine nasal spray should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). Store in a cool, dry place. Keep away from heat and light. Do not refrigerate or freeze. Nasal dihydroergotamine vials must be thrown away 8 hours after opening.

Side Effects

What are the most common side effects of nasal dihydroergotamine?

The most common side effects of nasal dihydroergotamine are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Runny or stuffy nose
  • Nausea, vomiting, or diarrhea
  • Change in how things taste
  • Local irritation (see below)
  • Dizziness
  • Drowsiness
  • Sore throat

There may be other side effects of nasal dihydroergotamine that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of nasal dihydroergotamine?

While less common, the most serious side effects of nasal dihydroergotamine are described below, along with what to do if they happen.

Severe Allergic Reactions. Nasal dihydroergotamine may cause allergic reactions, which can be serious. Stop using nasal dihydroergotamine and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching or skin rash
  • Bumps on the skin called hives that can be red, pink, white, or brown depending on your skin tone
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Heart Attack, Other Heart Problems, and Stroke. Nasal dihydroergotamine may increase your risk of heart attack, other heart problems (such as an abnormal heart rhythm), and stroke, which can lead to death. You may be at higher risk of these problems if you have risk factors for heart disease. Stop using nasal dihydroergotamine and get emergency help if you have any of the following symptoms.

  • Chest pain, pressure, or tightness
  • Fast or abnormal heartbeat
  • Trouble breathing
  • Pain in your back, neck, jaw, throat, or stomach
  • Unusual sweating
  • Nausea or vomiting
  • Feeling dizzy or lightheaded
  • Weakness or numbness on one side of your body
  • Loss of vision in one or both eyes
  • Sudden, severe headache with no known cause
  • Slurred speech or trouble understanding speech

Blood Flow Problems. Nasal dihydroergotamine can reduce blood flow to many areas of the body, which can be serious. Stop using nasal dihydroergotamine and tell your health care provider right away if you have any of the following symptoms.

  • Tingling, numbness, or change in color of fingers or toes
  • Muscle pain or weakness
  • Sudden or severe stomach pain
  • Weight loss
  • Constipation or diarrhea
  • Nausea or vomiting 
  • Fever

Increased Blood Pressure (Hypertension). Nasal dihydroergotamine may increase your blood pressure or make it worse if you have a history of high blood pressure. Call your health care provider if your blood pressure increases while using this medicine.

If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Increases in blood pressure may not be noticeable but look out for any of the following symptoms of severely high blood pressure.

  • Sudden severe headache
  • Chest pain
  • Dizziness or confusion
  • Trouble breathing
  • Nausea/vomiting
  • Blurry or other changes to vision
  • Anxiety
  • Buzzing in the ears
  • Nosebleed
  • Feeling of skipped heartbeats

Medicine Overuse Headache. Using nasal dihydroergotamine more often than prescribed may cause your headaches to happen more often or get worse. This is called medicine overuse headache or rebound headache. Keep track of how often you have headaches and how often you use nasal dihydroergotamine. If you notice your migraines happen daily or more frequently than before, or if they are getting worse, contact your health care provider.

Tissue Changes. Nasal dihydroergotamine can cause a buildup of scar tissue and inflammation around the lungs, stomach, or other organs, which is called fibrosis. This can happen in people using this medicine daily on a long-term basis. Do not use more medicine than prescribed. 

Local Irritation. Nasal dihydroergotamine can cause irritation to the nasal passages, which can sometimes be severe. Contact your health care provider if you have any of the following symptoms that bother you.

  • Runny or stuffy nose
  • Sore throat
  • Burning feeling in your nose, mouth, and throat
  • Change in taste or smell
  • Nasal or sinus discomfort
  • Ear discomfort

Warnings & Precautions

Who should not use nasal dihydroergotamine?

Allergies to Ingredients. People who are allergic to any of the following should not use nasal dihydroergotamine.

  • Dihydroergotamine
  • Migranal
  • Any other medicine known as an ergot alkaloid
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific nasal dihydroergotamine products they stock.

Drug Interactions. Nasal dihydroergotamine should not be used while you are using certain other medicines. If you use nasal dihydroergotamine with certain other medicines, it can cause severe blood flow problems to your feet or legs. This is a serious condition called peripheral ischemia, which can lead to symptoms such as cramping, pain, tingling, weakness or heaviness in your legs or feet. It can also lead to stroke or death. Before using nasal dihydroergotamine, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Kidney Problems. Nasal dihydroergotamine should not be used if your kidneys are not working as well as they should be. If there is a concern about the health of your kidneys, your health care provider may do tests to see if they are working well enough to use this medicine.

Liver Problems. Nasal dihydroergotamine should not be used if your liver is not working as well as it should be. If there is a concern about the health of your liver, your health care provider may do tests to see if it is working well enough to use this medicine.

Heart Problems or Uncontrolled High Blood Pressure. Nasal dihydroergotamine should not be used if you have or have had heart problems, including chest pain (angina), a heart attack, uncontrolled high blood pressure, or coronary artery vasospasm.  Tell your health care provider if you have any of these problems.

Blood Vessel Problems. Nasal dihydroergotamine should not be used if you have certain problems with your arteries or veins (peripheral vascular disease) or if you have had vascular surgery. Discuss these issues with your health care provider to help them decide if you can use nasal dihydroergotamine.

Other Types of Headache. Not all headaches can be treated with nasal dihydroergotamine. In particular, hemiplegic and basilar headaches should not be treated with nasal dihydroergotamine. Talk with your health care provider if you are unsure if you have these types of headaches.

What should I know about nasal dihydroergotamine before using it?

Do not use nasal dihydroergotamine unless it has been prescribed to you by a health care provider. Use it as prescribed. Do not use more of this medicine than prescribed, and do not use it every day. Using it more often than prescribed may increase the risk of serious side effects. See the Side Effects section for more details.

Do not share nasal dihydroergotamine with other people, even if they have the same condition as you. It may harm them.

Keep nasal dihydroergotamine out of the reach of children. 

Nasal dihydroergotamine should not be used to prevent migraines.  

Different nasal dihydroergotamine products may have different instructions for putting together the nasal pump, priming the pump before use, and how long the medicine is good for once it has been assembled. Make sure you read the instructions that come with your medicine for details. Knowing how to use nasal dihydroergotamine before you need it may be helpful when you are having a migraine. If you have any questions, contact your health care provider.

It may be helpful to keep a headache journal where you write down when you get your migraines and when you use nasal dihydroergotamine. This information could be shared with your health care provider to see how the medicine is working for you.

Nasal dihydroergotamine should not be injected.

What should I tell my health care provider before using nasal dihydroergotamine?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if nasal dihydroergotamine is right for you.

 In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Heart problems or a history of heart problems
  • High blood pressure
  • Risk factors for heart disease, such as high cholesterol, smoking, diabetes, or a family history of heart disease
  • Kidney or liver problems
  • Blood flow problems, including peripheral vascular disease or Raynaud’s syndrome
  • Stomach or intestinal problems

Pregnancy. Nasal dihydroergotamine may cause premature labor and should be avoided during pregnancy. Tell your health care provider right away if you are pregnant or plan to become pregnant.

Breastfeeding. Do not breastfeed while you are using nasal dihydroergotamine and for 3 days after your last dose. Nasal dihydroergotamine may pass into breast milk or reduce your breast milk supply. Tell your health care provider if you are breastfeeding or plan to breastfeed.

Interactions

Does nasal dihydroergotamine interact with foods or drinks?

Nasal dihydroergotamine can interact with grapefruit juice. Tell your health care provider if you eat grapefruit or drink grapefruit juice before using nasal dihydroergotamine.

It is unknown if drinking alcohol will affect nasal dihydroergotamine. The risk of drowsiness or dizziness may be increased if you drink alcohol while using nasal dihydroergotamine.

Does nasal dihydroergotamine interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using nasal dihydroergotamine.

  • A macrolide antibiotic, such as clarithromycin or erythromycin (Ery-Tab and others), which is a medicine used for bacterial infections
  • Fluconazole (Diflucan), itraconazole (Sporanox, Tolsura), ketoconazole, posaconazole (Noxafil), or voriconazole (Vfend), which is a medicine used for fungal infections
  • A protease inhibitor, such as nelfinavir (Viracept) or ritonavir (Norvir), which is a medicine commonly used to treat HIV
  • Any other ergot, such as dihydroergotamine (Migranal, Trudhesa, and others) or ergotamine (Ergomar), which is a medicine used to treat migraine
  • A triptan, such as eletriptan (Relpax), sumatriptan (Imitrex and others), and others, which is a medicine commonly used to treat migraines
  • A beta-blocker, such as atenolol (Tenormin), metoprolol (Lopressor, Toprol XL, and others), or propranolol (Inderal LA, Innopran XL), which is a medicine that may be used for certain heart conditions or to lower blood pressure
  • A vasoconstrictor, such as pseudoephedrine for nasal congestion, which is a medicine that can cause blood vessels to narrow
  • A selective serotonin reuptake inhibitor (SSRI), such as fluoxetine, paroxetine, or sertraline, which is a medicine commonly used for anxiety and depression
  • Nicotine, which can be found in cigarettes, vapes, or products that help you stop smoking

Many other medicines may alter the blood levels of nasal dihydroergotamine. Tell your health care provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with nasal dihydroergotamine. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much nasal dihydroergotamine?

If you or someone else has used too much nasal dihydroergotamine, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of nasal dihydroergotamine?

Nasal dihydroergotamine is meant to be used only when needed. Use it as your health care provider recommends. Do not use double or extra doses.