Ergotamines for Cluster Headaches

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Ergotamines for Cluster Headaches


Generic NameBrand Name
dihydroergotamine Migranal
ergotamine with caffeineCafergot

Dihydroergotamine can also be given through a vein (intravenous, or IV) or by an injection in the muscle (intramuscular, or IM) for emergency treatment of a severe cluster headache.

How It Works

Ergotamine narrows blood vessels in the head (vasoconstriction), which relieves pain by reducing pressure on pain-sensitive structures in the head and scalp that may be associated with cluster headaches. This drug may also affect certain brain chemicals that affect how a person feels pain.

Why It Is Used

Dihydroergotamine and ergotamine are used to stop a cluster headache. Ergotamine may also be used to prevent cluster headaches during a cluster cycle.

How Well It Works

When taken at bedtime or several hours before going to sleep, ergotamine is especially useful for preventing headaches at night.1

The nasal spray form of dihydroergotamine can help reduce the pain of a cluster headache when used at the first sign you are getting one.2

Dihydroergotamine, which is generally given as a shot, may provide rapid relief of a headache. A person may be able to give his or her own shot.

Side Effects

Side effects are more common with high doses and may include:

  • Nausea and vomiting.
  • Cold, clammy hands and feet (due to narrowing of blood vessels).
  • Muscle pain.
  • Dizziness, numbness, vague feeling of discomfort or anxiety.
  • Bitter or foul taste in the mouth or throat (nasal spray only).
  • Irritation or inflammation in the nose (nasal spray only).

Ergotamine may be combined with caffeine or other medicines to help control nausea and vomiting, which are common side effects of the medicine.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

To treat a cluster headache that has already begun, ergotamine must be used as early as possible for best results. The sooner you treat the headache, the less painful it may be.

If you are taking ergotamine, be sure to follow your doctor's instructions on when and how often to take it. Overuse of ergotamine can lead to a rebound headache.

Ergotamine should not be used with serotonin receptor agonists (triptans), such as sumatriptan, zolmitriptan, naratriptan, or rizatriptan.

Ergotamine should not be used to treat headaches in children. And it should not be used in women who are pregnant or who are thinking about becoming pregnant.

Also, ergotamine should not be used by people who have:

  • A fever.
  • Uncontrolled high blood pressure (hypertension).
  • Cerebrovascular, cardiovascular, or peripheral arterial diseases.
  • Coronary or ischemic heart disease.
  • Liver (hepatic) or kidney (renal) diseases.
  • Enlarged prostate.
  • Bowel obstruction.
  • Recent surgery.
  • Glaucoma.
  • A history of irregular heartbeat (arrhythmia).
  • Problems with circulation.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.



  1. Ropper AH, Samuels MA (2009). Cluster headache section of Headache and other craniofacial pains. In Adams and Victor's Principles of Neurology, 9th ed., pp. 174–176. New York: McGraw-Hill.
  2. Capobianco DJ, Dodick DW (2006). Diagnosis and treatment of cluster headache. Seminars in Neurology, 26(2): 242–259.


By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Primary Medical Reviewer Adam Husney, MD, MD - Family Medicine
Specialist Medical Reviewer Seymour Diamond, MD - Neurology
Specialist Medical Reviewer Colin Chalk, MD, CM, FRCPC - Neurology
Last Revised May 27, 2010

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