The use of methylergonovine (Methergine) in the initial control of drug induced refractory headache.

This study investigated the efficacy of methylergonovine maleate (Methergine) in the treatment of drug induced refractory headache (DIRH). Sixty consecutive patients (51 female and 9 male) diagnosed with DIRH were treated with methylergonovine maleate for a maximum of six months, using a within subject design. All patients were withdrawn from the medications they were taking upon entering the study. Concurrently, they were given 0.2-0.4 mg of methylergonovine maleate three times a day. Patients were provided the means to control breakthrough episodes of headache. Treatment outcome was assessed using a patient self-report scale (much better, better, same, worse, and much worse), and also visual analogue pain intensity scales. The side effects of the drug were assessed with patient self-report. Methylergonovine was effective in 44 (73%) patients. Twelve (20%) patients reported unchanged pain and 4 (6%) patients got worse. Side effects were reported by 24 patients. These were predominantly abdominal cramping. It is concluded that methylergonovine maleate is effective in the initial control of drug induced refractory headache. However, because methylergonovine is a metabolic byproduct of methysergide, the possibility or fibrotic disorders needs to be considered if methylergonovine is to be used for long term therapy.