Arterial complications of migraine treatment with methysergide and parenteral ergotamine

Abstract

Cluster headaches, which are associated with abnormal dilatation of the carotid artery and wall oedema, may be managed with methysergide and ergotamine. These drugs promote arterial constriction. Large artery spasm may rarely complicate treatment with either drug and is more likely when ergotamine is administered parenterally. The authors report on two patients in whom arterial spasm and tissue infarction developed during concurrent treatment with methysergide and parenteral ergotamine. This combination appears to create a particularly high risk of arterial spasm. These two patients developed occlusion of major arteries while taking methysergide and parenteral ergotamine for cluster headache. Arteriograms showed arterial spasm and collateral vessels, which are features of ergotism. These signs have been described in both ergotamine and methysergide toxicity in many areas of the arterial circulation. Thrombosis may also occur.