Intra-arterial administration of papaverine should be considered in the treatment of toxicity resulting from administration of which treatment for migraine headaches?
Dihydroergotamine (DHE) has a spectrum of toxicity that can include profound vasospasm leading to digital ischemia which may manifest as paresthesias with anesthesia, digital discoloration, and vacillating hyper- or hypotension in affected extremities. Clinicians should evaluate pulses in all extremities independent of any systemic or proximal blood pressure measurements. Papaverine is either derived naturally from the opium poppy (it is in the family of benzylisoquinoline alkaloids) or synthesized naturally. It can be administered intra-arterially following diagnosis with computed tomography angiography or conventional intra-arterial angiography.
Michael E. Mullins (2018) Ergot toxicity from high-dose dihydroergotamine for intractable migraine headache, Toxicology Communications, 2:1, 3-5, DOI: 10.1080/24734306.2017.1415666
Contributed by: Joseph Kennedy