Headache. 2010 Mar 26.
Revisiting the Role of Ergots in the Treatment of Migraine and Headache.
Baron EP, Tepper SJ.

From the Headache Center, Cleveland Clinic, Cleveland, OH, USA.

(Headache 2010;**:**-**) The harmful side effects of the ergots described by early civilizations have been overcome with efficacious treatment for headaches including migraine, CLUSTER, and chronic daily headache. Use of ergots contributed to initial theories of migraine pathogenesis and provided the substrate for development of the triptans. Triptans are very efficacious for many migraineurs, and since their widespread use, use of ergots has significantly declined. Unfortunately, there remain many migraineurs who benefit little from triptans, yet respond very well to ergots. Discoveries in migraine pathophysiology have given us better understanding of the complex processes involved, although there remain many unknown factors in migraine treatment. Additional, unrecognized therapeutic targets may exist throughout the neuronal connections of the brainstem, cortex, and cerebral vasculature. Ergots interact with a broader spectrum of receptors than triptans. This lack of receptor specificity explains potential ergot side effects, but may also account for efficacy. THE ROLE OF ERGOTS IN HEADACHE SHOULD BE REVISITED, ESPECIALLY IN VIEW OF NEWER ERGOT FORMULATIONS WITH IMPROVED TOLERABILITY AND SIDE EFFECT PROFILES, SUCH AS ORALLY INHALED DIHYDROERGOTAMINE. Redefining where in the headache treatment spectrum ergots belong and deciding when they may be the optimal choice of treatment is necessary.

PMID: 20353432 [PubMed]

I have been using DHE IM injections since late in my last cycle of 2008. It's available in inhaler form called Migranal. The inhaler worked much to slow for me.

For me the DHE shot will  stop a K-9 in around 5 min. I then get 24hrs PF so sleeping is an option. I don't take it every day as max dose per week is 6. Also my insurance doesn't limit this med like the triptans, they don't work well for me anyway.

Don