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Migranal Side Effects

Generic name: dihydroergotamine

Medically reviewed by Last updated on Jan 16, 2022.

Note: This document contains side effect information about dihydroergotamine. Some of the dosage forms listed on this page may not apply to the brand name Migranal.

In Summary

Common side effects of Migranal include: nausea and rhinitis. Other side effects include: application site reaction, vomiting, and altered sense of smell. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to dihydroergotamine: nasal spray


Nasal route (Solution)

Serious and/or life-threatening peripheral ischemia has been associated with the coadministration of dihydroergotamine with potent CYP3A4 inhibitors including protease inhibitors and macrolide antibiotics. Because CYP3A4 inhibition elevates the serum levels of dihydroergotamine, the risk for vasospasm leading to cerebral ischemia and/or ischemia of the extremities is increased. Hence, concomitant use of these medications is contraindicated.

Side effects requiring immediate medical attention

Along with its needed effects, dihydroergotamine (the active ingredient contained in Migranal) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur while taking dihydroergotamine:

Less common or rare

  • Chest pain
  • cough, fever, sneezing, or sore throat
  • feeling of heaviness in chest
  • irregular heartbeat
  • itching of the skin
  • numbness and tingling of face, fingers, or toes
  • pain in arms, legs, or lower back
  • pain in back, chest or left arm
  • pale bluish-colored or cold hands or feet
  • shortness of breath or troubled breathing
  • weak or absent pulses in legs

Symptoms of overdose

  • Confusion
  • convulsions (seizures)
  • delirium
  • dizziness
  • headaches
  • nausea and/or vomiting
  • numbness, tingling, and/or pain in the legs or arms
  • shortness of breath
  • stomach pain

Side effects not requiring immediate medical attention

Some side effects of dihydroergotamine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Burning or tingling sensation, dryness, soreness, or pain in the nose
  • change in sense of taste
  • diarrhea
  • dizziness
  • dry mouth
  • fatigue
  • headache
  • increased sweating
  • nausea and or vomiting
  • muscle stiffness
  • runny and or stuffy nose
  • sudden sweatings and feelings of warmth
  • sensation of burning, warmth, or heat
  • sore throat
  • sleepiness
  • unexplained nose bleeds
  • unusual tiredness or weakness

Less common

  • Anxiety
  • blurred vision
  • cold clammy skin
  • confusion
  • congestion in chest
  • cough
  • decreased appetite
  • depression
  • difficulty swallowing
  • dizziness or lightheadedness when getting up from a lying or sitting position
  • ear pain
  • eye pain
  • fever
  • heartburn
  • increased watering of eyes
  • increased watering of the mouth
  • increased yawning
  • muscle weakness
  • nervousness
  • pinpoint red spots on skin
  • pounding heartbeat
  • red or irritated eyes
  • ringing or buzzing in ears
  • skin rash
  • stomach pain
  • sudden fainting
  • swelling of face, fingers, feet, or lower legs
  • trembling or shaking of hands or feet
  • trouble in sleeping
  • unusual feeling of well being

For Healthcare Professionals

Applies to dihydroergotamine: injectable solution, nasal spray


The most commonly reported adverse events have included nausea and vomiting; with use of the nasal spray, rhinitis, altered sense of taste, and application site reactions have also been reported.


Deaths due to cardiac events have been reported with parenteral use, but no cardiac related deaths were reported during clinical studies with the nasal spray. Reports of serious cardiac events with the injection appear to be rare.[Ref]

Uncommon (0.1% to 1%): Edema, palpitation, tachycardia

Rare (less than 0.1%): Hypotension, peripheral ischemia, angina, cardiac valvular fibrosis

Frequency not reported: Acute myocardial infarction, transient myocardial ischemia, ventricular tachycardia, ventricular fibrillation, coronary artery vasospasm, bradycardia, extrasystoles, intermittent claudication, Raynaud's phenomenon

Postmarketing reports: Vasospasm, hypertension, flushing, peripheral ischemia, gangrene[Ref]

Nervous system

Common (1% to 10%): Dizziness, somnolence, paraesthesia

Uncommon (0.1% to 1%): Tremor, hypoesthesia, altered sense of smell

Rare (less than 0.1%): Speech disorder, hyperkinesia, stupor, abnormal gait, depression, aggravated migraine, convulsions

Frequency not reported: Cerebral hemorrhage, subarachnoid hemorrhage, stroke, headache[Ref]


Very common (10% or more): Local irritation (nasal spray; 30%)

Common (1% to 10%): Application site reactions

Uncommon (0.1% to 1%): Local anesthesia[Ref]

Almost 30% of patients receiving the nasal spray reported irritation in the nose, throat, and/or disturbances in taste. Symptoms of congestion, burning, dryness, paraesthesia, discharge, epistaxis, pain, and soreness, mostly mild to moderate and transient, have been reported. In most (approximately 70%), symptoms resolved within 4 hours. The consequence of extended and repeated use on the nasal mucosa have not been studied.[Ref]


Very common (10% or more): Rhinitis (nasal spray; 26%)

Common (1% to 10%): Pharyngitis, sinusitis

Uncommon (0.1% to 1%): Dyspnea, upper respiratory tract infections

Rare (less than 0.1%): Bronchospasm, bronchitis, pleural pain, epistaxis, yawning

Postmarketing reports: Pleural fibrosis[Ref]


The most frequent side effect with the use of intravenous dihydroergotamine (the active ingredient contained in Migranal) is nausea. Following intramuscular or intranasal administration, the incidence of nausea is lower.[Ref]

Common (1% to 10%): Nausea, vomiting, diarrhea

Uncommon (0.1% to 1%): Abdominal pain, dyspepsia, hiccup, dry mouth

Rare (less than 0.1%): Increased salivation, esophagospasm, anorexia

Frequency not reported: Colonic ischemia

Postmarketing reports: Retroperitoneal fibrosis[Ref]


Uncommon (0.1% to 1%): Vertigo, tinnitus, earache, feeling cold, malaise, rigors, fever, fatigue, asthenia[Ref]


Common (1% to 10%): Stiffness

Uncommon (0.1% to 1%): Cramps, myalgia, muscular weakness, dystonia

Rare (Less than 0.1%): Arthralgia, involuntary muscle contractions, rigidity

Frequency not reported: Leg pain, muscle spasms[Ref]


Frequency not reported: Renal artery spasm[Ref]


Frequency not reported: Hypersensitivity reactions such as skin rash, face edema, urticaria, and dyspnea


Uncommon (0.1% to 1%): Photophobia, conjunctivitis, abnormal lacrimation, abnormal vision, periorbital edema

Rare (less than 0.1%): Eye pain


Uncommon (0.1% to 1%): Nervousness, euphoria, insomnia, impaired concentration

Rare (less than 0.1%): Anxiety


Uncommon (0.1% to 1%): Petechia, pruritus, rash, cold clammy skin

Rare (less than 0.1%): Papular rash, urticaria, herpes simplex

Frequency not reported: Sweating


Uncommon (0.1% to 1%): Increased micturition frequency, cystitis

Rare (less than 0.1%): Pelvic inflammation, vaginitis

Frequently asked questions


1. Robbins L, Remmes A "Outpatient repetitive intravenous dihydroergotamine." Headache 32 (1992): 455-8

2. Malaquin F, Urban T, Ostinelli J, Ghedira H, Lacronique J "Pleural and retroperitoneal fibrosis from dihydroergotamine ." N Engl J Med 321 (1989): 1760

3. "Product Information. D.H.E. 45 (dihydroergotamine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.

4. Backonja M, Beinlich B, Dulli D, Schutta HS "Haloperidol and lorazepam for the treatment of nausea and vomiting associated with the treatment of intractable migraine headaches ." Arch Neurol 46 (1989): 724

5. Schulman EA, Rosenberg SB "Claudication: an unusual side effect of DHE administration." Headache 31 (1991): 237-9

6. "Drugs for migraine." Med Lett Drugs Ther 37 (1995): 17-20

7. Lipton RB "Ergotamine tartrate and dihydroergotamine mesylate: safety profiles." Headache 37 Suppl (1997): s33-41

8. Mattsson E, Ohlin A, Balkfors B, Fredin HO, Nilsson P, Bergqvist D "Lower-limb vasospasm and renal failure during postoperative thromboprophylaxis. Case report." Eur J Surg 157 (1991): 289-92

9. Bachner EJ, Konsens RM, Priem L, King T, Froimson AI "Reversible vasospasm in association with the use of heparin and dihydroergotamine." Clin Orthop No. 283 (1992): 261-4

10. Henry PY, Larre P, Aupy M, Lafforgue JL, Orgogozo JM "Reversible cerebral arteriopathy associated with the administration of ergot derivatives." Cephalalgia 4 (1984): 171-8

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.