Transient Exacerbation Of Headache In Patients Receiving Intravenous Dihydroergotamine For Inpatient Management Of Chronic Migraine Does Not Alter Outcomes (P7.197)

OBJECTIVE: To assess if transient worsening of headache associated with intravenous dihydroergotamine infusion has any prognostic significance in patients with chronic migraine. Other factors that might predict medium-term outcome were also assessed. BACKGROUND: Inpatient courses of intravenous dihydroergotamine (DHE) have been used for more than two decades to treat chronic migraine. DESIGN/METHODS: We reviewed our use of DHE for the inpatient management of chronic migraine. Follow-up typically occurred at six weeks, where medium-term outcome was assessed. We used both univariate and multivariate logistic regression models to assess for predictors of outcome. RESULTS: A total of 274 patients with chronic migraine who underwent an inpatient course of intravenous DHE were assessed. Overall, 78% of patients had medium-term headache benefit following treatment. A univariate logistic regression model suggested the presence of headache exacerbation with dihydroergotamine decreased the likelihood of a positive medium-term outcome (OR 0.43, 0.20-0.91, p = 0.03). However in the multivariate logistic regression model headache exacerbation was no longer an independent negative predictor of treatment outcome (OR 0.65, 0.28-1.51, p =0.31). Factors that independently predicted outcome included nausea (OR 0.12, 0.02-1.00, p =0.05), age (OR 1.68, 1.24-2.28, for each decade increase in age , p =0.001) and medication overuse prior to treatment (OR 0.42, 0.18-0.97, p =0.04). CONCLUSIONS: After controlling for nausea and other factors, headache exacerbation with DHE infusions is not an independent predictor of poor headache outcome. Clinicians should not interpret its presence as a reason to stop treatment early. Focus should be on controlling nausea as it is the most important modifiable factor in achieving a good outcome with an inpatient course of intravenous dihydroergotamine for chronic migraine. Study Supported by: NIH/NINDS, grant number: K12NS01692 Disclosure: Dr. Eller has received personal compensation for activities with the Fromm Institute. Dr. Eller has received personal compensation in an editorial capacity for Watch Neurology. Dr. Gelfand has received personal compensation in an editorial capacity for Journal Watch Neurology. Dr. Riggins has nothing to disclose. Dr. Schankin has received personal compensation for activities with Allergan Inc. as a meeting participant. Dr. Shankin has received research support from the German Research Foundation (DFG). Dr. Goadsby has received personal compensation for activities with Allergan, Inc., Colucid, MAP Pharmaceuticals, Merck Sharp & Dohme Limited, eNeura, ATI, Boston Scientific Corporation, Eli Lilly & Company, Medtronic, Inc., Bristol-Myers Squibb Company, Amgen Inc., Arteaus, AlderBio, Pfizer Inc., Zogeniz, Nevrocorp, Ipmax, DrReddy, and Zosano. Dr. Goadsby has received research support from Amgen Inc., Merck Sharp & Dohme Limited, and Allergan, Inc.