Ergotamine Tartrate in Migraine Attack and Tolerance Development

Abstract

Background: Migraine is a primary headache disorder with accompanying combinations of neurological, autonomic and gastrointestinal manifestations. Migraine spesific agents such as triptans, dihydroergotamine and ergotamine are recommended in the acute treatment of severe migraine attacks that cause a decline in individual's quality of life and socioeconomic level, in which nonsteroid antiinflammatory drugs, simple or combination analgesics are insufficient. Objective: The aim of this study is to evaluate the patients with the diagnosis of migraine that used ergotamine tartrate retrospectively, and to investigate the possible side-effects, tolerance development due to ergotamine tartrate. Material and Methods: Two hundred and five patients who attended to the headache polyclinic of our faculty with the diagnosis of migraine due to IHS (International Headache Society) criteria who used ergotamine tartrate once in their lifetimes were evaluated retrospectively. Tolerance development, overuse and side-effects were investigated in these patients. Results: Mean illness duration of the patients was 10.83±5.02 years (3-30 years) and the mean duration of ergotamine tartrate usage was 2.46± 1.29 years (1-1O years). Ergotamine tartrate tolerance wasdetermined in the 118 (57.5%) of the patients at the mean duration of 1.96±7.04 years (1-7 years). Seventy six (64.4%) of these patients increased the ergotamine tartrate dosage, while the remaining 42 (35.6%) did not increased the dosage despite its necessity. The mean initial ergotamine tartrate dosage of the patients who increased the dosage was found to be 5.92±2.12 (1-10) tablets, while the mean dosage was found to be 20.63±8.21 (8-30) tablets after tolerance development. Eighty seven (42.5%) of the patients withdrew ergotamine tartrate without dose increasement due to its side-effects, on an average of 1.96± 1. 10 years (1-5 years). It is possible to summarize the side-effects as nausea-vomiting (14.6%), sedation (10.2%), hypertension (6.3%), myalgia (4.8%), myocardial infarction (2.9%), diarrhea (2.4%) and bradycardia (1.3%).Conclusions: Migraine is a chronic disease coursing with recurrent headache attacks. Resistance to treatment, recurrent headaches and transformation to chronic daily headache is more frequent at the patients in need of attack treatment and unresponsive to simple analgesics. While planning the attack treatment of the patients under such potential risk, tolerance development and the increased risk of side-effects due to drug abuse has to be considered. It is important to consider that ergotamines which were a good choice in the times prior to the usage of triptans, may lead to complex, irreversible situations, particularly in the patients without frequent doctor control.