I really like dihydroergotamine as a migraine abortive for several reasons. For one, it actually is a natural product. It is extracted from the ergot fungus pod grown in the lab and purified. Secondly, if it can get into your system it is one of the most effective migraine abortives. Thirdly, it has no chance of causing rebound, unlike the triptan drugs and lastly, it last much longer than the triptans.
The down side is that it is hard to get dihydroergotamine past the gut. Sure, IV works well but is not practical for home use. Plus, when given IV, it causes a lot of nausea, the last thing you want when you already have a bad headache. Then there are the shots under the skin. I have several patients doing that. It is complicated and the injectable dihydroergotamine is about $75 a shot (was about $5 a shot back in the 80s).
So, the nasal spray seemed to be a good solution. However, about two years ago . . . literally overnight . . . the company that makes branded Migranal increased the price about 1000% overnight. It did sneak beneath the radar of the insurance companies for awhile. Once they figured it out most of them said, “hell no we are not paying for that” (over $800 for 8 doses). I will mention a couple other problems with the nasal spray and this, a) for some people they don’t absorb medications very well through the nose and b) the nasal spray does have the side effect of causing the nose to feel plugged.
Well, this week the nasal spray went generic. That’s great news. However, in the complexities of the generic and branded pharmaceutical companies It wouldn’t be surprised that the price stays up for a while. But I hope in a few months it will become a reasonable price that will make it much easier to use.