Diagnosis and Treatment of Headache. DHE (Dihydroergotamine Mesylate) Algorithm.

[Return to Migraine Treatment Algorithm, box 48]

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Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of headache. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Jan. 72 p. Diagnosis and Treatment of Headache DHE (Dihydroergotamine Mesylate) Algorithm The patient would enter this algorithm from box 46 of the Migraine Treatment Algorithm. DHE protocol algorithm Metoclopramide 10 mg IV. A *Begin continuous DHE 3 mg / 1000cc IV at 42 ml / hr (0.125 mg / hr). *Metoclopromide q 8 hours PRN nausea. A Continuous or repetitive DHE? DHE test dose *DHE 0.5 mg IV over 2-3 minutes. A Return to Box 48 in the Migraine Treatment Algorithm BP stable / no chest pain? A Discontinue DHE Common side effects. A Headache persists no common side effects Headache relief no common side effects Metoclopramide 10 mg IV q 8H PRN nausea. No DHE for 8 hours, then 0.3-0.4 mg IV x5 doses q 8 hours for 3 days. Repeat DHE 0.5 mg IV in 1 hour (without Metoclopramide) *Metoclopramide 10 mg IV q 8 hours PRN nausea, followed by *DHE 0.5 mg IV q 8 hours for 2-5 days. Return to "Migraine Treatment", box 48 Nausea? Return to Migraine Treatment Algorithm, box 48 Caution: DHE must not be given to or continued in patients who develop the following conditions: *Pregnancy. *History of ischemic heart disease. *History of Prinzmetal's angina. *Severe peripheral vascular disease. *Onset of chest pain following administration of test dose. *Within 24 hours of receiving any triptan or ergot derivative. *Elevated blood pressure. *Patients with hemiplegic or basilar-type migraines. * Basilar-type migraine is defined as three of the following features: diplopia, dysarthria, tinnitus, vertigo, transient hearing loss or mental confusion (Headache Classification Subcommittee of the International Headache Society, 2004) *Metoclopramide 10 mg IV x5 doses q 8 hours PRN nausea, followed by *DHE 0.75 mg IV q 8 hours for 2-5 days. *Metoclopramide 10 mg IV q 8 hours PRN nausea, followed by *DHE 1.0 mg IV q 8 hours for 2-5 days. Return to Migraine Treatment Algorithm, box 48 A = Annotation All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.