So - i won't have a chance to see my neuro, but I am going to see my primary care doc to ask him to prescribe Migranal.  Assuming he's not experienced with it, what is the dosing and how many can typically be prescribed at a time?  Is it an aerosol can with 20 inhalations that can be used across multiple clusters?  Or is it like imitrex/zomig nasal, it's a one per headache type of thing?
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Also, does anyone take it as part of a regimen and not as an abortive?  I heard it works for a long time, helping chronics like me not get headaches on a given day, etc.

Sorry that no one has responded. I've no experience or studies and so didn't write.

Go to START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE and search. Nice collection of material which will help.

I suspect the absence of responses says that few of our folks use it. Ergotamine in a spray form was my first abortive, many years ago, and it wasn't consistently helpful. Timing was critical and even then perhaps 50% effective. Not as a preventive, only abortive: its half-life is very short even for an attack.

Use this site to explore any med of interest. Easy to read material.

Send me a PM if I haven't posted several pieces of chronic treatment. Can't recall whether I shot this stuff to you earlier.

When I was prescribed Migranal, it came in a glass vial, the top of which had to be snapped off before use. The open vial is then inserted into the spray applicator and you spray twice up each nostril before throwing it away.

Apparently plastic can leach the good stuff out of solution, so it has to be kept in glass.

Hey Bob, i've gotten some great info from you thank you, not the least of which is the lithium / verapamil info. 
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I got some good info on the ergot.. seems much like what you said, but for those it does work for, it is slow to work, but long acting.  We will see i have it waiting at the pharmacy.  will be careful not to mix with triptans.

In 2007 I used Migranal and found it too slow to abort but helpful as a preventative. Since 2008 I've been using DHE (ergotamine) Intra-muscular injections. This aborts well for me and gives up to 24 hrs PF.

DHE can be given Sub-Q. For some reason Sub-Q didn't work for me but IM does. DHE is the active agent in Migranal both are not to be used with Triptans within 24 hrs.

If the Migranal is of any help then the injections may be an option.

Don

I've also had the DHE-45 IV treatment as an inpatient. 1mg every 8 hours for three days. Works like a charm - until you're home and you miss the next two pushes. Rebound much? For a week solid. I'll never do it again.

If you get a script for standard, name-brand (U.S.) Migranal, this is what you'll get--a box of 8 "kits", each in its own box. Each kit contains a glass vial with rubber stopper, and a separate spray nozzle to attach. Also, each kit contains 4 mg/mL dihydroergotamine mesylate.

For each attack, you are intended to assemble one kit (one bottle plus nozzle). You should use one half of the bottle to try aborting the attack. If you still have the CH an hour later, you can use the rest of the spray bottle then. And they say you should discard any un-used doses, as they have a short shelf-life.

I use DHE IM 1mg injections up to twice a day as a preventative. It usually works great, but sometimes 12 hour apart doesn't cut it and I start needing it more often or I'll have clusters break through.

Migranal spray never helped me like the DHE injections do.

Also, the labeling on the DHE says for IM OR IV USE ONLY. DHE isn't going to be nearly effective if given SubQ for some reason.

I am chronic and have been using this stuff for years. It's been a real life saver for me.

DHE IM injections can also be used as an abortive for many.

I4B

Everyone - thanks!  I did get the standard kit as described.  I'm going to use it to abort the first attack of  the day when it comes, hopefully it will work as described, maybe a little slow, but long acting.

Thanks!

So yeah, with the Migranal... like others, I found that it was a bit slower than Imitrex injections but longer-lasting (less chance of headache recurrence). It does smell kind of musty, btw. And make sure not to try inhaling or sniffing it... it's meant to be absorbed by the lining of your nose, so you should spray it without sniffing in. Hope it works!