Practice Based Learning: Use of dihydroergotamine (DHE) for pediatric migraines

Kelly Harris, MD

Presented by Kelly Harris, MD
Resident, Department of Pediatrics
Emory University

Key Points:

  • Headaches are the 3rd leading cause of referral to pediatric ED with ~20% of these attributable to migraines
  • DHE appears to be safe in children without ischemic heart disease/basilar or hemiplegic migraines with major side effects consisting of Nausea and Vomiting
  • DHE appears to be effective in treatment of migraines and may have longer effect than Depakote
  • Initiating actual Raskin Protocol (rather than modified) may shorten length of hospital stay
  • There is an ongoing need for double-blind, placebo controlled studies for acute migraine treatments in children


Edwards KR, Norton J, Behnke M. Comparison of intravenous valproate versus intramuscular dihydroergotamine and metoclopramide for acute treatment of migraine headache. Headache. 2001 Nov-Dec;41(10):976-80.

Hämäläinen ML, Hoppu K, Santavuori PR. Oral dihydroergotamine for therapy-resistant migraine attacks in children. Pediatr Neurol. 1997 Feb;16(2):114-7.

Kabbouche MA, Powers SW, Segers A, LeCates S, Manning P, Biederman S, Vaughan P, Burdine D, Hershey AD. Inpatient treatment of status migraine with dihydroergotamine in children and adolescents. Headache. 2009 Jan;49(1):106-9.

Lewis DW, Yonker M, Winner P, Sowell M. The treatment of pediatric migraine. Pediatr Ann. 2005 Jun;34(6):448-60.

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