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Subsequently, clinical practice guidelines were formulated and recently published in Neurology.

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The Headache and Facial Plan Section and the QSS of the AAN were able to reach consensus on the basis of a thorough literature review and formulated practice parameters that describe and define the limits of ergot use, provide information on the oral and parenteral dosing of ET and DHE, and provide physicians with guidance to avoid ET overuse by patients.

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Because this project was completed prior to the availability of the intranasal (IN) formulation of DHE, intranasal DHE is not included in the practice parameter.

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In addition, the committee recommended restricting the use of ET in some instances because the overuse of ET has been associated with physical and psychological dependence resulting in predictable recurrent and/or rebound headaches, and subsequent severe withdrawal symptoms, including nausea, upon discontinuance of ET.


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