D.H.E. 45® (Dihydroergotamine) Injection for Acute Migraine Relief

What D.H.E. 45® Is and How It Works

Dihydroergotamine (DHE) is an ergot alkaloid for acute migraine and cluster headache attacks. The injectable form, often known by the brand D.H.E. 45, contains dihydroergotamine mesylate 1 mg/mL in single-dose or multi-dose vials. YouDrugstore is a licensed Canadian pharmacy headquartered in Manitoba; prescriptions are reviewed by licensed pharmacists before dispensing. Many patients look for Dihydroergotamine without insurance, and our Canadian pricing helps control out-of-pocket costs.

Dihydroergotamine works by constricting dilated intracranial blood vessels and inhibiting neurogenic inflammation. This dual action can reduce migraine pain and associated symptoms such as photophobia and nausea. The injection may be given subcutaneously, intramuscularly, or intravenously under medical supervision. Because it is an acute treatment, it is used at the start of an attack rather than daily for prevention.

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Dosage and Usage

• Typical adult dosing: 0.5–1 mg per injection for acute attacks. Route may be subcutaneous (SC) or intramuscular (IM); intravenous (IV) dosing is used in supervised settings.
• Repeat dosing: May repeat once after appropriate interval if symptoms persist. Do not exceed 3 mg in 24 hours for SC/IM use. For IV use, many protocols limit to 2 mg per 24 hours.
• Weekly maximum: Do not exceed 6 mg in one week. Some protocols allow up to 8–10 mg when including non-IV routes; follow prescriber directions.
• Use restrictions: Do not use within 24 hours of a triptan or any ergot-containing medicine.
• Antiemetic: Clinicians often pair DHE with an anti-nausea medicine such as metoclopramide.
• Missed dose: DHE is used at attack onset. If not administered during the attack as directed, wait until the next attack for the next opportunity.
• Administration steps (vial): Wash hands. Inspect the solution; do not use if discolored or contains particles. Clean the vial stopper. Use a sterile syringe and needle to draw the prescribed dose. Remove air bubbles. Inject SC/IM as trained. Dispose of sharps in a puncture-resistant container.
• Injection sites: Common SC/IM sites include the thigh, upper arm, and abdomen (avoid the navel area). Rotate sites to reduce irritation.
• Supervised IV use: IV dosing is typically administered in a clinic or infusion setting with monitoring.

• Storage: Store vials at 20–25°C (68–77°F). Protect from light by keeping vials in the carton. Do not freeze.
• Handling: Do not use if the seal is broken or the solution is cloudy or precipitated.
• Travel: Keep vials and syringes in your hand luggage with your prescription. Avoid temperature extremes and direct sunlight.
• Transport: Use a protective case. Do not leave vials in a hot car or on ice.
• Disposal: Carry a small sharps container for used needles when traveling.

Benefits and Savings

Dihydroergotamine injection can work even when a triptan has failed. It offers multiple routes. SC or IM dosing can be used at home when prescribed and trained. IV administration in clinics may be part of a status migrainosus protocol. Recurrence rates can be lower versus some alternatives.

Ordering from Canadian pharmacies can lower costs by 60–80% compared with typical US pricing. This helps those paying cash or using Dihydroergotamine price without insurance. You may reduce the per-month cost with multi-month supplies when appropriate. Reorder reminders help avoid gaps in therapy.

Dihydroergotamine Injection promo details are updated on our promotions page when available.

Side Effects and Safety

• Common effects: nausea, vomiting, flushing, dizziness, fatigue, paresthesia, muscle cramps, and injection-site pain or redness.
• Less common: diarrhea, sweating, taste changes, nasal stuffiness, or transient chest tightness.
• Vascular effects: cold hands or feet, numbness, tingling in fingers or toes.
• Allergic reaction: rash, itching, swelling, or trouble breathing.

Serious risks include severe vasospasm with reduced blood flow to the heart, brain, or limbs, which can lead to ischemia, myocardial infarction, or stroke. Do not combine DHE with potent CYP3A4 inhibitors (such as certain macrolide antibiotics, azole antifungals, or protease inhibitors) due to life-threatening vasospasm. Avoid use in pregnancy or while breastfeeding. People with coronary artery disease, peripheral vascular disease, uncontrolled hypertension, hemiplegic or basilar migraine, severe hepatic or renal impairment, or sepsis should not use DHE. Do not smoke while using ergots.

Onset Time

Onset depends on route. IV dosing often helps within 30–60 minutes. SC or IM dosing may take 45–90 minutes, with continued improvement over 2 hours. Some patients repeat a dose as directed to reduce recurrence. For cluster headache, IV protocols in monitored settings may act rapidly.

Compare With Alternatives

Sumatriptan is a first-line triptan for many attacks. The nasal route can help those with nausea or vomiting. If a triptan is preferred, consider Imitrex® Nasal Spray. Do not use DHE within 24 hours of any triptan.

Zolmitriptan is another option with a nasal spray route. It may suit people who need non-oral delivery and a different triptan profile. See Zomig® Nasal Spray for details.

Other options include newer oral acute treatments (gepants or ditans) for those who cannot use triptans or ergots. Preventive agents such as CGRP monoclonal antibodies are used separately to reduce attack frequency.

Combination Therapy

• Antiemetics (e.g., metoclopramide or prochlorperazine) are commonly paired with DHE to manage nausea and improve tolerability.
• NSAIDs or acetaminophen may be used separately in some protocols. Monitor total use to avoid medication-overuse headache.
• Preventive therapies (e.g., CGRP monoclonal antibodies, beta-blockers, topiramate) can be continued; they do not replace acute DHE treatment.
• Do not use DHE within 24 hours of triptans or other ergots to limit vasoconstriction risk.
• Avoid potent CYP3A4 inhibitors and nicotine due to increased vascular risks.

Patient Suitability and Cost-Saving Tips

Adults with severe or refractory migraine or cluster headache may be considered for DHE. It is not suitable for people with significant cardiovascular disease, uncontrolled hypertension, peripheral vascular disease, severe renal or hepatic impairment, sepsis, or for pregnant or breastfeeding individuals. Those with hemiplegic or basilar-type migraine should avoid ergots.

To manage costs, compare brand and generic options when available. Choose larger pack sizes when they fit the prescribed regimen, as multi-pack purchases may lower the per-vial price. Set up reorder reminders so you always have doses on hand before travel or busy periods. Many customers ask about Dihydroergotamine Injection cost without insurance; Canadian pricing can help reduce out-of-pocket spend.

Authoritative Sources

FDA Prescribing Information for D.H.E. 45 (dihydroergotamine mesylate) injection

DailyMed: Dihydroergotamine Mesylate Injection

Health Canada Drug Product Database: Dihydroergotamine Mesylate Injection

Order D.H.E. 45® from YouDrugstore: add to cart, upload your prescription, and we ship with prompt, express, cold-chain handling.

This content is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.