Description and Brand Names

Drug information provided by: IBM Micromedex

US Brand Name

  1. Migranal


Dihydroergotamine belongs to the group of medicines called ergot alkaloids. It is a nasal solution used to help relieve migraine headaches. Nasal dihydroergotamine is not an ordinary pain reliever. It will not relieve any kind of pain other than throbbing headaches.

Nasal dihydroergotamine may cause blood vessels in the body to constrict (become narrower). This action can lead to serious effects that are caused by a decrease in the flow of blood (blood circulation) to many parts of the body. Be sure that you discuss with your doctor the risks of using this medicine as well as the good it can do.

This medicine is available only with your doctor's prescription.

This product is available in the following dosage forms:

  • Spray

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:


Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.


There is no specific information comparing use of nasal dihydroergotamine in children with use in other age groups.


There is no specific information comparing use of nasal dihydroergotamine in older adults with use in other age groups.


Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using this medicine.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Almotriptan
  • Amprenavir
  • Atazanavir
  • Azithromycin
  • Boceprevir
  • Clarithromycin
  • Cobicistat
  • Cocaine
  • Darunavir
  • Delavirdine
  • Dirithromycin
  • Dobutamine
  • Dopamine
  • Eletriptan
  • Ephedrine
  • Epinephrine
  • Erythromycin
  • Fosamprenavir
  • Frovatriptan
  • Idelalisib
  • Indinavir
  • Itraconazole
  • Josamycin
  • Ketoconazole
  • Letermovir
  • Lidocaine
  • Lopinavir
  • Mepartricin
  • Midodrine
  • Mifepristone
  • Miokamycin
  • Naratriptan
  • Nefazodone
  • Nelfinavir
  • Norepinephrine
  • Phenylephrine
  • Phenylpropanolamine
  • Posaconazole
  • Propylhexedrine
  • Pseudoephedrine
  • Ritonavir
  • Rizatriptan
  • Rokitamycin
  • Roxithromycin
  • Saquinavir
  • Saralasin
  • Spiramycin
  • Sumatriptan
  • Telaprevir
  • Telithromycin
  • Tipranavir
  • Troleandomycin
  • Vasopressin
  • Voriconazole
  • Zolmitriptan

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abametapir
  • Alefacept
  • Berotralstat
  • Bromocriptine
  • Ceritinib
  • Conivaptan
  • Crizotinib
  • Dexfenfluramine
  • Eluxadoline
  • Enzalutamide
  • Erdafitinib
  • Fluconazole
  • Fluvoxamine
  • Fosnetupitant
  • Imatinib
  • Lanreotide
  • Lefamulin
  • Lorlatinib
  • Lumacaftor
  • Netupitant
  • Octreotide
  • Pazopanib
  • Propatyl Nitrate
  • Ranolazine
  • Ribociclib
  • Selpercatinib
  • Sibutramine
  • Tucatinib
  • Voxelotor

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Nitroglycerin
  • Propranolol

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Grapefruit Juice

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Heart or blood vessel disease or
  • Hypertension (high blood pressure) or
  • Kidney disease or
  • Liver disease or
  • Infection—The chance of serious side effects caused by nasal dihydroergotmine may be increased. Heart or blood vessel disease and high blood pressure sometimes do not cause any symptoms, so some people do not know that they have these problems. Before deciding whether you should use nasal dihydroergotamine, your doctor may need to do some tests to make sure that you do not have any of these conditions.

Proper Use

It is important to use this medicine properly. Make sure that you read the patient directions carefully before using this medicine.

Do not use nasal dihydroergotamine for a headache that is different from your usual migraine. Instead, check with your doctor.

To relieve your migraine as soon as possible, use nasal dihydroergotamine as soon as the headache begins. Even if you get warning signals of a coming migraine (an aura), you should wait until the headache pain starts before using nasal dihydroergotamine.

Lying down in a quiet, dark room for a while after you use this medicine may help relieve your migraine.

If you feel much better after a dose of nasal dihydroergotamine, but your headache comes back or gets worse after a while, you may use more nasal dihydroergotamine. However, use this medicine only as directed by your doctor. Do not use more of it, and do not use it more often, than directed.

Your doctor may direct you to take another medicine to help prevent headaches. It is important that you follow your doctor's directions, even if your headaches continue to occur. Headache-preventing medicines may take several weeks to start working. Even after they do start working, your headaches should occur less often, and they should be less severe, and easier to relieve. This can reduce the amount of nasal dihydroergotamine or other pain medicines that you need. If you do not notice any improvement after several weeks of headache-preventing treatment, check with your doctor.


The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For nasal dosage form (nasal solution):
    • For migraine headaches:
      • Adults—One spray (0.5 mg) in each nostril. After 15 minutes, another spray (0.5 mg) in each nostril should be used.
      • Children—Use and dose must be determined by your doctor.


Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.


Drinking alcoholic beverages can make headaches worse or cause new headaches to occur. People who suffer from severe headaches should probably avoid alcoholic beverages, especially during a headache.

Some people feel drowsy or dizzy during or after a migraine attack, or after taking nasal dihydroergotamine to relieve a migraine headache. As long as you are feeling drowsy or dizzy, do not drive, use machines or do anything else that could be dangerous if you are dizzy or are not alert.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Less common or rare

  1. Chest pain
  2. cough, fever, sneezing, or sore throat
  3. feeling of heaviness in chest
  4. irregular heartbeat
  5. itching of the skin
  6. numbness and tingling of face, fingers, or toes
  7. pain in arms, legs, or lower back
  8. pain in back, chest or left arm
  9. pale bluish-colored or cold hands or feet
  10. shortness of breath or troubled breathing
  11. weak or absent pulses in legs

Symptoms of overdose

  1. Confusion
  2. convulsions (seizures)
  3. delirium
  4. dizziness
  5. headaches
  6. nausea and/or vomiting
  7. numbness, tingling, and/or pain in the legs or arms
  8. shortness of breath
  9. stomach pain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  1. Burning or tingling sensation, dryness, soreness, or pain in the nose
  2. change in sense of taste
  3. diarrhea
  4. dizziness
  5. dry mouth
  6. fatigue
  7. headache
  8. increased sweating
  9. nausea and or vomiting
  10. muscle stiffness
  11. runny and or stuffy nose
  12. sudden sweatings and feelings of warmth
  13. sensation of burning, warmth, or heat
  14. sore throat
  15. sleepiness
  16. unexplained nose bleeds
  17. unusual tiredness or weakness

Less common

  1. Anxiety
  2. blurred vision
  3. cold clammy skin
  4. confusion
  5. congestion in chest
  6. cough
  7. decreased appetite
  8. depression
  9. difficulty swallowing
  10. dizziness or lightheadedness when getting up from a lying or sitting position
  11. ear pain
  12. eye pain
  13. fever
  14. heartburn
  15. increased watering of eyes
  16. increased watering of the mouth
  17. increased yawning
  18. muscle weakness
  19. nervousness
  20. pinpoint red spots on skin
  21. pounding heartbeat
  22. red or irritated eyes
  23. ringing or buzzing in ears
  24. skin rash
  25. stomach pain
  26. sudden fainting
  27. swelling of face, fingers, feet, or lower legs
  28. trembling or shaking of hands or feet
  29. trouble in sleeping
  30. unusual feeling of well being

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.