• Migraine and headache

Migranal Generic Name & Formulations

General Description

Dihydroergotamine mesylate 4mg/mL (0.5mg/spray); nasal spray; contains caffeine.

Pharmacological Class

Ergot alkaloid.

How Supplied

Nasal spray—8 units (vial + sprayer)

Generic Availability


Migranal Indications


Acute treatment of migraine.

Migranal Dosage and Administration


1 spray in each nostril, repeat 15mins later; max 6 sprays/24hrs and 8 sprays/wk.


Not established.

Migranal Contraindications


Ischemic heart disease. Coronary artery vasospasm (eg, Prinzmetal's angina) or myocardial ischemia. Peripheral artery disease. Sepsis. Post-vascular surgery. Uncontrolled hypertension. Other significant cardiovascular disease. Severely impaired hepatic or renal function. Basilar or hemiplegic migraine. Concomitant potent CYP3A4 inhibitors (eg, ritonavir, nelfinavir, indinavir, erythromycin, clarithromycin, troleandomycin, ketoconazole, itraconazole) or other vasoconstrictors. Within 24 hours of other ergot-type drugs or 5-HT1 agonists.

Migranal Boxed Warnings

Boxed Warning

Peripheral ischemia following coadministration with potent CYP3A4 inhibitors.

Migranal Warnings/Precautions


Confirm diagnosis. Exclude underlying cardiovascular disease, supervise 1st dose, and consider monitoring ECG in patients with likelihood of unrecognized coronary disease (eg, postmenopausal women, men over age 40, hypercholesterolemia, hypertension, obesity, diabetes, smokers, strong family history). Monitor cardiovascular function in long-term intermittent use. Compromised circulation. Medication overuse headache. Elderly. Pregnancy: avoid. Nursing mothers: not recommended (during and for 3 days after the last dose).

Migranal Pharmacokinetics

See Literature

Migranal Interactions


Other ergots, 5-HT1 agonists, potent CYP3A4 inhibitors, other vasoconstrictors: see Contraindications. Potentiated by CYP3A4 inhibitors (eg, protease inhibitors, macrolides, azole antifungals, saquinavir, nefazodone, fluoxetine, fluvoxamine, grapefruit juice, zileuton), propranolol, nicotine.

Migranal Adverse Reactions

Adverse Reactions

Rhinitis, pharyngitis, dysgeusia, local reactions (congestion, burning sensation, dryness, paresthesia, epistaxis, pain), nausea, vomiting, dizziness, somnolence; myocardial and peripheral vascular ischemia or vasoconstriction (ergotism: discontinue if occurs).

Migranal Clinical Trials

See Literature

Migranal Note

Not Applicable

Migranal Patient Counseling

See Literature