Dihydroergotamine
Dihydroergotamine is an ergot derivative used primarily for the acute treatment of migraine and cluster headaches. It works by constricting cranial blood vessels and blocking pain pathways involved in headaches. The medication is available in injectable, nasal spray, and oral formulations.
Dihydroergotamine is a migraine and cluster headache medication that relieves pain by narrowing blood vessels in the brain.
This medication carries a boxed (black box) warning — the strongest type of FDA warning. Review the full prescribing information before use.
Key facts at a glance
- ATC
- N02CA01
- RxNorm
- 3418
- Generic
- Dihydroergotamine
- Class
- atc-n02
- Brands
- Trudhesa, Atzumi, Brekiya, Migranal
- Availability
- rx
- Lactation
- unknown
- Routes
- nasal, sublingual, oral
- Forms
- injection, powder, tablet, spray
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 0.4-1 mg
- Maximum
- consult physician
- Frequency
- as needed, may repeat every 1-2 hours up to 2 mg daily maximum
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 0.01 mg/kg
- Maximum
- consult physician
- Frequency
- as needed, up to 0.5 mg single dose maximum
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 0.2-0.5 mg
- Maximum
- consult physician
- Frequency
- as needed, may repeat every 1-2 hours up to 1.5 mg daily maximum
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
7 groupspregnancy
all trimestersavoid use
contraindicated during pregnancy due to risk of uterine contractions and fetal distress
discontinue if pregnancy occurs
Use of this medication in this population requires careful consideration of risks and benefits.
lactation
breastfeedingdo not use
contraindicated - do not breastfeed during treatment and for 72 hours after last dose
monitor infant for signs of ergotism
Use of this medication in this population requires careful consideration of risks and benefits.
pediatric_age
adolescents under 18not recommended
not approved for use in patients under 18 years of age
not applicable
Use of this medication in this population requires careful consideration of risks and benefits.
geriatric
elderly over 65reduce initial dose
use with caution due to increased cardiovascular sensitivity; start at lowest effective dose
monitor blood pressure and cardiovascular status
Use with caution and monitor for adverse effects.
renal_impairment
severe renal impairmentreduce dose and increase dosing interval
use with caution; monitor for ergot toxicity
monitor renal function and for signs of ergotism
Use with caution and monitor for adverse effects.
hepatic_impairment
moderate to severe hepatic impairmentreduce dose
use with caution; drug is extensively metabolized in liver
monitor liver function and for signs of ergot toxicity
Use with caution and monitor for adverse effects.
alcohol_users
concurrent alcohol useavoid combination
concurrent use with alcohol may increase risk of vasospastic reactions
monitor for signs of peripheral ischemia
Use of this medication in this population requires careful consideration of risks and benefits.
Statistics and clinical data
FDA approval year
Original FDA approval for dihydroergotamine injection
Drug class
ATC classification N02CA01
Primary indication
Treatment of acute migraine attacks with or without aura
Common routes
Multiple administration routes available including self-administration
Acute treatment of migraine headaches with or without aura, and cluster headaches. Typically used when standard analgesics are insufficient or contraindicated.
Acts as a serotonin (5-HT1B/1D) receptor agonist, causing constriction of expanded cranial blood vessels and inhibiting inflammatory neuropeptide release, thereby interrupting the migraine process.
Contraindicated in patients with cardiovascular disease, peripheral vascular disease, uncontrolled hypertension, or during pregnancy. Should not be used with strong CYP3A4 inhibitors or other vasoconstrictors. May cause nausea, vomiting, or nasal discomfort depending on formulation.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed August 24, 2026. · Read our editorial policy