{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T16:40:55Z","timestamp":1772815255733,"version":"3.50.1"},"reference-count":43,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2013,9,11]],"date-time":"2013-09-11T00:00:00Z","timestamp":1378857600000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Headache"],"published-print":{"date-parts":[[2013,9]]},"abstract":"\n Orally inhalable dihydroergotamine (\n iDHE<\/jats:styled-content>\n ), before the\n US F<\/jats:styled-content>\n ood and\n D<\/jats:styled-content>\n rug\n A<\/jats:styled-content>\n dministration in 2013 for consideration for approval for acute treatment of episodic migraine in adults, is a user\u2010friendly formulation of an older medication. Dihydroergotamine (\n DHE<\/jats:styled-content>\n ) has a heterogeneous receptor profile, central penetration, and persistent receptor binding that may account for its clinical prolonged benefits in acute treatment of migraine. The same features may result in the ability of\n DHE<\/jats:styled-content>\n to reverse central sensitization and allodynia and to maintain efficacy deep into attacks. These characteristics make\n DHE<\/jats:styled-content>\n particularly useful in treating migraine upon awakening, prolonged migraine and status migrainosus, menstrually related migraine, and for bridging patients out of medication\u2010overuse headache\/chronic migraine. The inhalable formulation has helpful pharmacokinetics, with a lower maximal serum concentration than intravenous\n DHE<\/jats:styled-content>\n which may account for minimal nausea, and less binding to the potentially toxic serotonin\n \n 2B<\/jats:sub>\n <\/jats:styled-content>\n receptor. The inhaler itself is designed for delivery of reproducible aliquots of intrapulmonary\n DHE<\/jats:styled-content>\n with only nominal need for patient coordination. The inhalable form allows for bypassing the gastrointestinal tract in the setting of migraine nausea or vomiting, and greatly reduces first\u2010pass effect. No drug\u2010related serious adverse events were reported during the\n P<\/jats:styled-content>\n hase 3 study of\n iDHE<\/jats:styled-content>\n . Product taste and nausea were the most common side effects in both the\n P<\/jats:styled-content>\n hase 3 regulatory trial and in the safety extension trial. Limitations for use of\n iDHE<\/jats:styled-content>\n are those for any ergot or triptan, ie, contraindication in the setting of vascular disease. In addition,\n iDHE<\/jats:styled-content>\n is metabolized by the cytochrome\n P450 3A4<\/jats:styled-content>\n liver enzymatic system. Inhalable\n DHE<\/jats:styled-content>\n provides the promise of a new formulation of a valued medication with important clinical features, useful deep into attacks in a variety of situations.\n <\/jats:p>","DOI":"10.1111\/head.12184","type":"journal-article","created":{"date-parts":[[2013,9,11]],"date-time":"2013-09-11T13:11:05Z","timestamp":1378905065000},"page":"43-53","source":"Crossref","is-referenced-by-count":27,"title":["Orally Inhaled Dihydroergotamine: A Review"],"prefix":"10.1111","volume":"53","author":[{"given":"Stewart J.","family":"Tepper","sequence":"first","affiliation":[{"name":"Cleveland Clinic Cleveland OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,9,11]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"61","volume-title":"Handbook of Clinical Neurology, Vol 21, Intoxications of the Nervous System. 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