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Migranal
Migranal (generic name: dihydroergotamine mesylate) is a prescription migraine medication used to treat acute migraine attacks with or without aura in adults. Migranal belongs to the ergot alkaloid class of drugs and works by narrowing blood vessels around the brain, which helps reduce the symptoms of migraine, such as headaches, throbbing pain, and sensitivity to light and sound. It is used for acute migraine relief but is not intended for the prevention of migraines.
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Frequently Asked Questions
How long does it take for Migranal to work?
Migranal usually begins to relieve migraine symptoms within 30 to 60 minutes after administration, with full effects occurring over a few hours.
How long does it take for Migranal to work?
Migranal usually begins to relieve migraine symptoms within 30 to 60 minutes after administration, with full effects occurring over a few hours.
Can I use Migranal for more than one migraine in a day?
No, Migranal should not be used more than once for a single migraine attack. Additionally, it should not be used more than twice per week.
What should I do if Migranal does not relieve my migraine?
If Migranal does not provide relief, or if your migraine symptoms worsen, contact your healthcare provider. Do not take additional doses beyond the recommended amount.
Can I use Migranal if I have high blood pressure?
Migranal is not recommended for individuals with uncontrolled high blood pressure due to its vasoconstrictive effects, which can worsen hypertension.
Is Migranal safe to use during pregnancy?
No, Migranal is contraindicated during pregnancy, as it can cause harm to the fetus, including uterine contractions and reduced placental blood flow.
Comprehensive Drug Guide
How Does Migranal Work?
Migranal works by constricting the dilated blood vessels in the brain that are believed to contribute to migraine symptoms. It also binds to various serotonin (5-HT) receptors, which helps regulate vascular tone and reduces inflammation associated with migraines. By activating certain serotonin receptors, Migranal narrows blood vessels, providing relief from migraine pain and other related symptoms.
Common Dosages
- 1 spray (0.5 mg) in each nostril, repeated in 15 minutes, for a total dose of 2 mg (4 sprays).
Typical Dosing
- The standard dosing for treating an acute migraine attack with Migranal is:
- 1 spray in each nostril (0.5 mg per nostril) at the onset of a migraine.
- After 15 minutes, repeat the dose with 1 spray in each nostril, for a total dose of 4 sprays (2 mg total).
- Do not exceed 4 sprays (2 mg) in any single migraine attack.
- Migranal should not be used more than twice per week.
Typical Dosing
FDA Approved Indications
- Acute treatment of migraine attacks with or without aura in adults.
Who Shouldn't Take Migranal?
- Known hypersensitivity to dihydroergotamine or any component of the formulation.
- Uncontrolled hypertension.
- Peripheral vascular disease or conditions affecting blood circulation.
- Ischemic heart disease or a history of heart attack or angina.
- Pregnancy, as it may cause harm to the fetus.
- Concomitant use with strong CYP3A4 inhibitors (e.g., ketoconazole, erythromycin), due to the risk of severe vasospasm.
Advice From The Pharmacist
- Use Migranal only during a migraine attack. It is not intended for preventing migraines.
- Follow the dosing instructions carefully. Do not exceed the recommended dose or frequency, as overuse can lead to severe side effects.
- Before using the nasal spray, prime the device by pressing down on the pump 4 times.
- Store the nasal spray in a cool, dry place. After the first use, the spray bottle should be discarded within 8 hours.
- Avoid using other medications that can cause vasoconstriction (like triptans) or CYP3A4 inhibitors at the same time as Migranal, as this can lead to dangerous narrowing of the blood vessels.
Side Effects of Migranal
Common Side Effects
- Nasal congestion or irritation
- Dizziness or lightheadedness
- Nausea or vomiting
- Fatigue or tiredness
- Altered sense of taste
Uncommon/Severe Side Effects
- Chest pain or tightness, which may indicate a heart problem.
- Cold or numbness in the extremities, which may indicate restricted blood flow.
- High blood pressure.
- Allergic reactions, such as rash, swelling, or difficulty breathing.
Risks and Warnings of Migranal
- Cardiovascular Risks: Migranal should not be used in patients with cardiovascular diseases such as coronary artery disease, uncontrolled hypertension, or a history of stroke. The medication may cause vasoconstriction, which can worsen these conditions.
- Drug Interactions: Migranal should not be used in combination with triptans (another class of migraine medications), as the risk of severe vasoconstriction or heart attack increases. Additionally, CYP3A4 inhibitors can increase dihydroergotamine levels and lead to dangerous side effects.
- Overuse Headache: Using Migranal too frequently can lead to medication-overuse headaches. It should not be used more than twice per week.
- Pregnancy Warning: Migranal should not be used during pregnancy due to the risk of harm to the fetus, including uterine contractions and reduced blood flow to the placenta.
Interactions with Migranal
Common Drug Interactions
- CYP3A4 inhibitors (e.g., ketoconazole, ritonavir): These medications can increase the risk of severe vasospasm, leading to heart attacks, stroke, or other serious complications.
- Triptans: The combined use of Migranal and triptans (e.g., sumatriptan, rizatriptan) can result in severe vasoconstriction and should be avoided.
- Vasoconstrictive agents (e.g., nicotine, beta-blockers): Combining these drugs with Migranal may increase the risk of blood vessel constriction and related complications.
Alternatives to Migranal
- Imitrex (sumatriptan): A triptan used to treat acute migraine attacks, available as a tablet, nasal spray, or injection.
- Zomig (zolmitriptan): Another triptan used to treat migraines, available as an oral tablet, nasal spray, or orally disintegrating tablet.
- Maxalt (rizatriptan): A fast-acting triptan for treating migraine attacks.
- Ergomar (ergotamine): An alternative ergot alkaloid used for acute migraine treatment.
- Nurtec ODT (rimegepant): An orally disintegrating tablet used for acute migraine treatment and prevention.
