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        New Message Board Archives >> Medications, Treatments, Therapies 2004 >> What is DHE
        
(Message started by: Ruth on Sep 30^th, 2004, 5:48pm)

Title: What is DHE
Post by Ruth on Sep 30^th, 2004, 5:48pm

I am new to all of these new treatments and don't no what DHE is.

Ruth

Title: Re: What is DHE
Post by thomas on Sep 30^th, 2004, 5:50pm

Dihydroergotamine
Intravenous DHE, given every 8 hours, has completely stopped cluster attacks in 20 consecutive patients. For 7 of them, the bout was over following 3 days of DHE treatment, but this could have been coincidental (Raskin, unpublished observations).

Title: Re: What is DHE
Post by Ruth on Sep 30^th, 2004, 6:01pm

Thank you, so like it is a preventive type of treatment then.
Ruth

Title: Re: What is DHE
Post by thomas on Sep 30^th, 2004, 6:05pm

No it is used to try to "break" a cycle. Most people do it after their cycles get so bad they can't take it anymore and go in for this, it is an "in-patient" procedure, for the most part.

Title: Re: What is DHE
Post by Ruth on Sep 30^th, 2004, 6:12pm

I got it I think.
I think when the Doc put me on a Pred. taper, he thought that would break the cycle, but it didn't he also put me on a preventive med and that hasn't stopped them either.
I use imitrex injections to abort, I use the concervative method only using 1/3 of the vile for an attack. It works for me but I am still taking the prevevtive med, which is a channel blocker, Procardia.
thanks again thomas for the info.
Ruth

Title: Re: What is DHE
Post by vig on Sep 30^th, 2004, 10:02pm

Renee and Unsolved are doing it right now, I think.
Any reports from them?

"Intravenous DHE, given every 8 hours, has completely stopped cluster attacks in 20 consecutive patients. "

Has anybody found it helpful?

Title: Re: What is DHE
Post by don on Sep 30^th, 2004, 10:36pm

After 27 years of CH, IV DHE broke the worst cycle of my life and that was followed by a three year remission. The longest remission of my life.

Did it help me? I'll say it did. In fact my neuro and I have both agreed that if another cycle goes past the initial prednisone taper we will go immediate to the inpatient DHE treatment.

Title: Re: What is DHE
Post by vig on Sep 30^th, 2004, 10:39pm

Cool! let's here some more stories....

Title: Re: What is DHE
Post by thomas on Sep 30^th, 2004, 11:04pm

Broke a cycle for me too. One time shot too, no inpatient.

Title: Re: What is DHE
Post by reptile on Oct 1^st, 2004, 12:12am

I used DHE-45 for several years (it has been in use for a long time, I think), by injecting it into my thigh. In all but the worst of attacks, it worked well. It is, however, strongly contraindicated for cardivascular disease, so I had to give it up 7 years ago when I was found to had advanced heart artery disease.

Title: Re: What is DHE
Post by Lizzie2 on Oct 1^st, 2004, 12:26am

Wow I missed this thread big time!!!

I've been a DHE junkie since June of 2001. I get it inpatient for several days on end...about a week they will do it for me. In January of 2002, I was taught how to inject myself with DHE-45 IM injections. Now, I just let other nursing students inject me if I need it because I really can't stand to stick myself. DHE has had very mixed results for me, but I keep it around. I don't use it as much as I used to. I recently got it IV push in the emergency room along with a few other drugs. I have also used the nasal spray form, which is called Migranal. Migranal hasn't exactly had the success that IM or IV DHE has had.

I have to be careful with the use of DHE because I tend to have tachycardia (fast heart rate above 100bpm). One of the times I was in the hospital, the doc held the DHE if my heart rate was over 90. Then I was allowed to have it again if my heart rate would drop.

I find it is more effective than any triptan I've ever used except for Amerge...which takes wayyyyyyy too long to work!!

DHE also makes me really nauseous. When given IV, it should always be premedicated with something like Reglan, Droperidol, or various other meds that can be used to premedicate for DHE. I also always have to have Zofran shortly after getting DHE IV because it makes me throw up. But it is worth it...it has been far more successful for my cluster attacks than for my chronic daily headache, although it does help a bad spell with that to a degree.

I now have Zofran pills which I take for nausea, and I will definately be using them the next time I get DHE injected. It works like any other abortive...not safe to use more than 2 days a week. I know a lot of people here use imitrex nightly at times, but using DHE nightly probably isn't safe at all.

I know one person who used DHE 5 days a week and was unable to walk due to heavy vasoconstriction in her legs. It is possible to rebound off of DHE, so it must be used with caution!!

Love the stuff...myself!

Lizzie :)

Title: Re: What is DHE
Post by clavers on Oct 1^st, 2004, 11:24am

My nureologist switched me from Imitrex injections to DHE injecetions about 2 1/2 years ago. At first I injected 1cc under the skin. It worked well for about a year and then became less effective. He then told me to give the injections directly into a muscle. I Inject 1cc into my thigh into the place where when I flex the muscle seems hardest. This worked well for about a year then became less effective. I have now found that injecting 1cc into a muscle followed by breathing O2 the CH will stop and I won't have another for at least 24 hours. If you are where you can't get to O2 you are in trouble. When this stops working I don't know what I will do.

Title: Re: What is DHE
Post by unsolved1 on Oct 1^st, 2004, 8:11pm

DHE is usally given to me at .5mg doses every 6 hours until a max dose of 6 mg. DHE should be withheld from patients with a BP (top #) higher than 160 or (bottom #) higher than 90. Any previous heart problems will probably stop docs from using DHE. Your BP must be monitored carefully. You cannot use within 24 hours of Triptans or other ergotomines. Don't forget the Phengran !

It gives me a break for a few days but will not stop my cycle.

Unsolved

Title: Re: What is DHE
Post by Lizzie2 on Oct 1^st, 2004, 9:31pm

Another reminder:

An EKG is required!!!

Title: Re: What is DHE
Post by unsolved1 on Oct 1^st, 2004, 11:58pm

on 10/01/04 at 21:31:19, Lizzie2 wrote:

Another reminder:

An EKG is required!!!

Not a standard requirement for DHE. A neuro or doc may suggest that someone have one prior to getting DHE to rule out heart problems which could effect the decision to use DHE at all. BP monitoring is a must.

EKG's a required when using Droperidol

Unsolved

Title: Re: What is DHE
Post by Lizzie2 on Oct 2^nd, 2004, 1:07am

on 10/01/04 at 23:58:43, unsolved1 wrote:

Protocol at Jefferson. No DHE without an EKG. I agree with the droperidol too though. I hate that drug with a passion. Will never receive it without cogentin about a half hour prior or you will have to peel me off the ceiling.

I have my latest EKG from the ER a few weeks ago. They did it because I was getting DHE. I've had so many...and also done a few EKGs on headache patients because of the floor I used to work on!

Always fun times...

Title: Re: What is DHE
Post by sarahmom on Oct 5^th, 2004, 3:20pm

I was going through a horrible cycle, where NOTHING helped. Finally got an appt at the Cleveland Clinic with Dr. Stillman (who has been wonderful for me, btw). We drove 5 hours for the appointment (husband and I). I had my bag full of pills, folders of files, etc. etc. He started me on DHE IV for two days at the hospital, and then since I lived far away, set me up with home health care so I wouldnt have to stay in the hospital and could treat myself at home. I ended up wearing a pump of it (kind of like a diabetic insulin pump, but filled with DHE). I wore this until I was 24 hours completely pain-free (I had other things besides my clusters going on- I had migraines on top of my clusters, not a days peace in over 2 years, yada yada). I was in contact with the dr and his staff every single day while wearing the pump.
During this time, I had bad upper thigh pains. Tried to walk as much as I could to help it, but nothing really worked. Was on Phenegran for the nausea. Lost about 12lbs in the first week and a half. Absolutely could NOT eat!
I was on the pump for about 12 days I think? I would have to go home and read my journal I kept. I havnt had a cluster headache since (that has been since this summer). About two weeks after coming off the pump, I began to have what I learned were called "sunct" headaches. So, I take pills for those, too. But only when those start up.
I have had a few break through migraines, but I use the Migrainal nose spray to combat those (but only after I've taken a Phenegran). However, those nose spray gives me a really big gag reflex. Its horrible. However, I'd take the gag reflex any day over the pains of Migraines and Cluster headaches!!
I'm at work right now, i'll have to pull my journal (my husband and I kept a journal of the experience) out to be more specific on things that happened while I was on it.

Title: Re: What is DHE
Post by Renee on Oct 13^th, 2004, 8:03pm

I was at my wit's end and rebounding from narcotics given to me at the e.r. when I was admitted a couple of weeks ago for inpatient DHE IV every 8 hours. I was given Reglan IV 15 minutes prior to the DHE IV push and had no nausea problems. My clusters dwindled to shadows after the third IV push (24 hours) and were gone after the fourth IV push thus I was released after the 7th IV push. I was pain free until yesterday for the most part except for one day when storms were in the area.

Overall, my ch's are shorter lasting and milder than prior to my hospital stay and the o2 is more effective as well now. It is almost like the DHE gave my brain a fresh start at battling the beast.

I did suffer from muscle weakness in my legs during the treatments and shortly thereafter. As mentioned above, BP must be monitored. My BP was taken every 5 minutes during the IV push and then continued every 5 minutes after the IV push for another 30 minutes. My appetite was fine as it was SO nice to get relief.

I will definitely use this route again if I ever get to where the aborts are failing and all the clusters are high kip levels. Being chronic I do not see this as a cure but it is the largest band-aid I have ever found.

I hope this info helps,
Renee