{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:48:18Z","timestamp":1773881298556,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T00:00:00Z","timestamp":1695427200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dihydroergotamine (DHE), like triptans, is contraindicated in patients with ischemic heart disease or coronary vasospasm. Its true safety, tolerability, and efficacy in patients with cardiovascular risk without ischemic heart disease or coronary vasospasm remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the safety, tolerability, and effectiveness of repetitive intravenous DHE in patients with cardiovascular risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single\u2010center, retrospective cohort study was conducted at the Jefferson Headache Center inpatient unit for refractory chronic migraine patients treated with our intravenous DHE protocol between January 1, 2019, and October 15, 2019. We evaluated tolerability and effectiveness outcomes based on atherosclerotic cardiovascular disease 10\u2010year calculated risk scores, stratified into low (&lt;5.0%) and elevated (\u22655.0%) risk. Data were presented in mean\u2009\u00b1\u2009standard deviation or median (25th percentile, 75th percentile) if non\u2010normally distributed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 347 patients (median age of 46 [36, 57], female\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009278 [80.1%]), who received inpatient intravenous DHE, 227 patients (age 53 [45, 60], female 81.1%) had calculable risk scores, 64 (28.2%) had elevated risk, and 38 (16.7%) had cardiology consultations. There were no clinically significant electrocardiogram abnormalities or cardiovascular adverse events. The median hospital length of stay was 6 (5, 7) days. Compared to the low\u2010risk group, those with elevated risk had higher nausea (31.3% vs. 14.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008), but similar initial DHE dose (0.5 [0.25, 0.5] vs. 0.5 [0.25, 0.5],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009), lower final DHE dose (0.75 [0.5, 1] vs. 1 [0.75, 1]\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and lower pain reduction after admission (\u22123.8 [2.1, 6] vs. \u22125 [3, 7]\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.037).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients receiving intravenous DHE by the Jefferson Headache Center inpatient headache protocol had significantly reduced pain severity at discharge. No clinically significant cardiac or electrocardiogram abnormalities were detected in patients with elevated (or low) atherosclerotic cardiovascular disease risk. Repetitive intravenous DHE used by our protocol was safe in refractory chronic migraine patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.14636","type":"journal-article","created":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T03:05:07Z","timestamp":1695438307000},"page":"1251-1258","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Safety, tolerability, and effectiveness of repetitive intravenous dihydroergotamine for refractory chronic migraine with cardiovascular risk factors: A retrospective study"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1823-8557","authenticated-orcid":false,"given":"Victor S.","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Neurology Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Kosman","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University College of Population Health  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsiangkuo","family":"Yuan","sequence":"additional","affiliation":[{"name":"Jefferson Headache Center, Department of Neurology Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3225-4446","authenticated-orcid":false,"given":"Clinton","family":"Lauritsen","sequence":"additional","affiliation":[{"name":"Jefferson Headache Center, Department of Neurology Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Shrewsbury","sequence":"additional","affiliation":[{"name":"Impel Pharmaceuticals Inc.  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9425-1710","authenticated-orcid":false,"given":"Sheena K.","family":"Aurora","sequence":"additional","affiliation":[{"name":"Impel Pharmaceuticals Inc.  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Jefferson Headache Center, Department of Neurology Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Silberstein","sequence":"additional","affiliation":[{"name":"Jefferson Headache Center, Department of Neurology Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,9,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32279-7"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.13588"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S203650"},{"issue":"1","key":"e_1_2_10_5_1","first-page":"S33","article-title":"Ergotamine tartrate and dihydroergotamine mesylate: safety profiles","volume":"37","author":"Lipton RB","year":"1997","journal-title":"Headache"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2006.00601.x"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.36.7.995"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.1992.hed3209439.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182377dbb"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.1990.hed3006334.x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14172"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102414544977"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/1941874418797764"},{"issue":"18","key":"e_1_2_10_14_1","article-title":"Ischemia of the extremities caused by a combination of dihydroergotamine and triacetyloleandomycin. 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