Ergot antimigraine agents
- Older migraine drugs with mixed receptor actions
- Ergotamine/dihydroergotamine are prototypes
- Constrict cranial/systemic vessels
- More adverse effects than triptans/gepants
- Major CYP3A inhibitor interactions can be dangerous
- Avoid in vascular disease and pregnancy
Class at a glance
- Older migraine drugs with mixed receptor actions
Practical pearls
- Ergotamine/dihydroergotamine are prototypes
Pharmacology
- Major CYP3A inhibitor interactions can be dangerous
Other practical pearls
- Constrict cranial/systemic vessels
Safety / monitoring
- More adverse effects than triptans/gepants
- Avoid in vascular disease and pregnancy
Pearls
- Ergotamine: nausea and vomiting common
- Dihydroergotamine better tolerated than ergotamine; nasal spray irritates nose
- Fever or liver impairment heightens severe vasoconstriction risk
- Avoid in severe hepatic or renal impairment
- Use ≥10 days/month → medication-overuse headache
Self-check
- When should Ergot antimigraine agents generally be avoided?
Vascular disease and pregnancy. - What vascular action do ergot antimigraine agents have?
Constrict cranial/systemic vessels.
Drugs in this class (2)
Ergot antimigraine agents prescription history
Animated chart of estimated U.S. prescriptions per year, Migraine-specific meds (1936–2026). Ergot derivatives highlighted from 1936.
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