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Outpatient IV DHE
Magnoux E., Zlotnik G.
Posted October 2002
Headache 2002; 42:411

We reviewed all our refractory cluster headache patients who received IV DHE treatment in an out-patient setting between January 1992 and May 2000. The protocol is a variant of Raskinís one. On the first three days a nurse gives 1 mg. IV DHE in the morning and 1 mg. 8 hours later; in the evening patients are taught to give themselves 1 mg. of DHE SC. After these 3 days they take 1 mg. SC bid for 2 weeks with 1 mg. SC die for a third week. Complete resolution is defined as no headache for one month following treatment. Partial resolution is diminution of 50% or more of the frequency of headache. We found 104 treatments on 70 patients. All patients except 2 take preventive medication with verapamil in 87%, lithium in 42%, and valproate in 22%. Combination preventive therapy is taken in 52% of patients. There were 7 dropouts. 97 patients completed, 60 episodic cluster and 37 chronic cluster. Results for the total number of treatments gave complete resolution during the IV phase that persist at one month in 61/97 cases or 62%, partial resolution in 13/97 cases or 13% with a combination of 74%, and failure in 26/97 or 26%. In the episodic form, there was a complete resolution in 44/60 cases or 72%, partial resolution in 9/60 cases or 13% with combination of 53/60 or 84%, and failure in 7/60 cases or 15%. In the chronic form, there is complete resolution in 17/37 cases or 46%, partial resolution in 4/37 cases or 11% with combination of 21/37 cases or 57%, and 16/37 failure or 43%. In episodic form those who failed to respond tended to be older (mean age of 51 years) than those who responded (mean age of 41 years). Same for the lapse of time between diagnosis of the disease and time of treatment, with means of 16.3 years for failure and 13.8 years for success. In the case of chronic form we found the same tendency with mean ages of 44.5 years for failure and 39 years for success and lapse of time between diagnosis and IV treatment of 12.7 years for failure and 11.4 years for success. Regarding the tolerability and security of the treatment, there was suspected vasospastic angina in one patient on day 7 of the treatment when she was on the subcutaneous phase, two patients dropped out from fear of injection, one for palpitation, one for chest tightness and two others for leg cramps, nausea and diarrhea. As a secondary effect 40% of patients complained of nausea, 30% of diarrhea and 21% of leg cramps. Despite the limitation of this study, we can say that DHE IV can be used safely in an outpatient setting, is useful for treatment of refractory cluster and more effective in the episodic form than the chronic one. It does not change the evolution of the episodic form but it seems to affect the evolution of the chronic with induction of remission or transformation in episodic form. We suspect that older patients and longer-term disease had some negative effect on the sensitivity to treatment.