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PubMed1986

[Ergotism with cerebral complications. Case report and review of the literature].

Abuse of ergotamine-containing suppositories was followed by generalized vessel stenoses in a pregnant 29-year-old migraine patient and led to a space-occupying great brain infarction in the area supplied by the right internal carotid artery. Impressive improvement of clinical, computed tomography and ultrasound findings was observed during treatment with nimodipine. The literature about cerebral symptoms of ergotism is reviewed.

Adult↗
PubMed1979

Palate morphogenesis. IV. Effects of serotonin and its antagonists on rotation in embryo culture.

Previous studies have localized non-muscle contractile systems in the posterior (region 2) and the anterior (region 3) ends of mouse palates at the time of shelf movement. In order to determine whether these contractile systems function in shelf rotation, effects of pharmacologic agents have been analyzed in embryo culture. First, it was shown that the posterior end of the palate rotates before the anterior end, and its rotation in culture was proportionally greater as development of the embryo progressed. Generally, the posterior end of the palate was more easily inhibited in embryo culture than the anterior end. Serotonin at 10(-8) M to 10(-5) M was shown to significantly stimulate rotation at the anterior end of the palate after 2 h in embryo culture. The effect on the posterior palate was less pronounced. To investigate further the role of this neurotransmitter on palate shelf rotation, serotonin antagonists were employed. Methysergide (10(-4) M) inhibited anterior shelf rotation to 12% of control values (P less than 0.005), while not significantly affecting the posterior end. Ergotamine (10(-6) M) significantly inhibited the stimulation induced by 10(-5) M serotonin (P less than 0.025). Cyproheptadine (10(-9) M) partially inhibited anterior and posterior shelf rotation in embryo culture. When injected into the pregnant dam, cyproheptadine partially inhibited shelf rotation and fusion. The palate was examined histologically after embryo culture. In the presence of 10(-4) M methysergide, the elongated contractile cells in region 3 at the anterior and midpalatal mesenchyme were prevented from rounding. Thus, serotonin may be regulating rotation of the anterior end of the palate by an effect on cell-mediated process.

Animals↗
PubMed1978

[Effect of ergot alkaloid derivatives on milk secretion in the immediate postpartum period].

30 women received an intramuscular injection of 0.2 mg of methylergobasine immediately after delivery and then 3 tablets of 1 mg of ergotamine tartrate per mouth daily for 6 days post-partum. 28 women received no treatment after delivery. The selection of the two groups was random. The treatment with rye ergot derivatives did not have a significant effect on the quantity of milk that the infant took, nor on the infant's weight gain in the 6 first days of life.

Body Weight↗
PubMed1984

[Treatment of ergotism].

Ergotism occurs in patients so disposed, particularly under ergotamine therapy for migraine. The principal signs are arterial spasms in the legs, or sometimes also the arms, which can lead to gangrene. Intravenous or intra-arterial infusion of sodium nitroprusside or nitroglycerine has proved the only reliably efficacious therapy. The best results have been obtained using nitroprusside: twelve cases are described here. By contrast, nonefficacious measures include, in particular, sympathetic blockade.

Adult↗
PubMed1978

Observations on the treatment of an acute attack of migraine.

In 1976, 310 patients attended the Princess Margaret Clinic for treatment of an acute headache. 90% were either symptom-free or had only slight residual headache after 4 h. The treatment given was metaclopramide and an effervescent analgesic. 69% of patients had some form of sedation and 10% ergotamine tartrate. Those patients who had treatment between 6 and 12 h following the onset of an attack had significantly fewer attacks in the next 7 days. Patients who slept during an attack, with a sedative where indicated, recovered more quickly than those who did not sleep. The depth of sleep did not affect the rate of recovery. A higher percentage of patients with migraine compared with those with tension headache were either symptom-free or had only slight residual headache on leaving.

Acute Disease↗
PubMed1980

[Ergotism of therapeutic origin. A report of 4 new cases (author's transl)].

The observations concern ischemic accidents with various localizations (lower limbs, tongue, uterus, intestine, heart, liver) corresponding to 4 observations for which ergot derivatives (ergotamine tartrate) can be responsible. The most typical accidents are localized at the level of limbs and especially of lower limbs. In the greatest part of observations, a specific terrain (puerperium, vasomotor disorders, suspicion of temporal arteritis) can be considered and favouring factors (infection, and especially associated medicinal treatments with triacetyloleandomycin [2 observations] and Doxycyclin [1 observation]). The posologies of ergot alcaloïds were either superior to the limit prescription or normal. The duration of prescription was variable, but generally short. The arteriography confirms a vascular spasm. In an observation with very severe evolution, various ischemic localizations inducing amputation, two intestinal resections and an hemodialysis for lactic acidosis were noted. These ischemic accidents have to be noticed as early as possible in order to start a treatment; the best one seems to be the association of sodium nitroprussiate in intravenous perfusion with peri-dural anesthesia in an antalgic aim.

Adolescent↗
PubMed1980

[Severe ischemic accidents from ergotism. A report on 3 cases. Value of a new antidote : sodium nitropruside (author's transl)].

The autors describe 3 recent cases of severe ischemic accidents from ergotism affecting different regions. Two of the cases resulted from taking Gynergene (ergotamine tartrate) for a short period, while the other case followed continuous administration of Desernil (Methysergide) for 3 years. The third case was treated at a late stage by continuous peridural anesthesia and various vasodilators without success and led to very severe mutilations in two young women. The third case was treated by continuous infusions of sodium nitropruside (SNP) under hemodynamic control, and recovery was rapid and complete. The value of SNP as an antidote for severe ergotism is discussed, together with its mode of administration, and precautions necessary when prescribing this extremely powerful vasodilator treatment for this indication.

Adult↗
PubMed1995

Differential ergoline and ergopeptine binding to 5-hydroxytryptamine2A receptors: ergolines require an aromatic residue at position 340 for high affinity binding.

In this paper we show that a highly conserved aromatic residue, phenylalanine at the 340-position, is essential for ergoline binding to 5-hydroxytryptamine2A receptors. We hypothesized that F340 was essential for a specific aromatic-aromatic interaction (e.g., pi-pi or hydrophobic) between the phenyl moiety of F340 and the aromatic ring of the ergoline nucleus. To test this hypothesis, eight point mutations of adjacent (F340 and F339) and nonadjacent (F125) phenylanaines were made, using conservative (phenylalanine to tyrosine) and nonconservative (phenylalanine to leucine, alanine, or serine) substitutions. The binding affinities of all of the tested simple ergolines were greatly reduced by specific mutations of F340 in which aromatic-aromatic interactions (e.g., F340A and F340L) were abolished, but they were unaffected when the replacement residue was aromatic (e.g., F340Y). In contrast, the binding affinities of four ergopeptines (bromocryptine, ergocryptine, ergocornine, and ergotamine) were relatively unaffected by the F340L substitution. Neither ergoline nor ergopeptine affinities were consistently altered by F339 mutations. These results support the notion that aromatic-aromatic interactions (either pi-pi of hydrophobic) with F340 are essential for the binding of simple ergolines but not ergopeptines to 5-hydroxytryptamine2A receptors. Our findings support models of ergoline and ergopeptine binding to serotonin receptors that suggest that the nature of the substituent at the 8-position of the ergoline nucleus may give rise to different modes of binding for the two classes of agents, particularly with respect to the phenyl ring of F340.

Animals↗
PubMed1994

Migraine: a pharmacologic review with newer options and delivery modalities.

The management of migraine usually centers on two approaches: preventive and abortive therapy. Preventive therapy, designed to reduce the frequency, duration, and intensity of attacks, can be accomplished through a wide variety of medications. The most commonly used are beta-blockers, but calcium channel blockers, antidepressants, anticonvulsants, and nonsteroidal anti-inflammatory agents have all been used with success. Agents used in abortive migraine therapy treat the intensity and duration of pain, as well as the associated symptoms. New treatment options have been developed, including such newly approved medications as sumatriptan. Sumatriptan is a very effective agent that has joined the ranks of other effective abortive migraine treatments, such as ergotamine, dihydroergotamine, and nonsteroidal anti-inflammatory agents, as well as narcotic analgesics. New delivery systems, such as the nasal-spray formulation of butorphanol, allow for a route of administration previously unavailable to migraine sufferers. These new and developing treatment modalities will give physicians a wider choice of outpatient therapy options.

Administration, Intranasal↗
PubMedDate not supplied

Lingual infarction in cranial arteritis.

An unusual case is described of infarction of the tongue as a presentation of cranial arteritis. The lingual necrosis may have been precipitated in part by the use of ergotamine to relieve the headache of the temporal arteritis, mistaken initially for migraine. The patient recovered with high-dose steroid therapy.

Aged↗
PubMed1994

Headache.

Headache-prone patients have many highly effective therapeutic options open to them. Used only at the time of headache, sumatriptan succinate by mouth or injection and dihydroergotamine nasal spray are novel choices now or soon to be available. The original migraine therapy, ergotamine, is highly effective in its rectal suppository formulation, when used at a subnauseating dosage. Valproate sodium is the latest addition to the many therapies available for long-term stabilization.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

[Pharmacotherapy of headache with special reference to migraine].

Drug therapy is only one possibility to treat headache or migraine. In a migraine attack aspirin, acetaminophen, non-steroidal antiinflammatory drugs like ibuprofen, naproxen and mefenamic acid are used. Further more weak opiates, caffeine, metoclopramide and the new 5-HT1-receptor agonist sumatriptan are effective in the attack. Ergotamine and dihydroergotamine are probably the most effective though their side effects are troublesome. For prophylactic treatment, the beta-adrenergic receptor blockers propranolol, metoprolol and atenolol are the drugs of first choice. Also calcium channel antagonists like flunaricine and antidepressant drugs like amitryptiline and doxepine are used.

Analgesics↗
PubMed1993

Acute and prophylactic treatment of migraine: practical approaches and pharmacologic rationale.

The antimigraine efficacy of many drugs may be mediated less through their primary modes of action than through the common pathway of serotonergic transmission stabilization. Migraine treatment may be symptomatic, acute/abortive, or prophylactic. Because oral drug absorption is impaired during attacks, parenteral agents are more appropriate for acute therapy. Acute agents include ergots and ergotamine derivatives, narcotics, and sumatriptan succinate. Agents that activate the 5-HT3 receptors must be administered with an antiemetic. Sumatriptan succinate, a specific 5-HT1 receptor agonist, does not necessitate adjunctive antiemetics. Stabilization regimens, such as those using valproate, may favorably alter the natural history of migraine. Sumatriptan succinate is appropriate both for acute attacks and for symptomatic management during stabilization. beta-Blockers, tricyclic antidepressants, and calcium antagonists may be used prophylactically.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1993

Chronic refractory headache.

Approximately 40% of patients seen in major headache clinics suffer from chronic daily headache. Of a series of 630 patients with chronic daily headache, 489 were diagnosed with transformed migraine, 84 with chronic tension-type headache, and 57 with new daily persistent headache. Of these patients, 73% overused symptomatic medication, particularly analgesics and ergotamine, and as a result, suffered from drug-induced headache or rebound headache.

Adult↗
PubMed1995

[Value of duplex ultrasound in diagnosis of ergotism of the legs].

Ergot's derivatives are widely used in the treatment of migraine and in the prophylaxy of deep venous thrombosis in association with heparin. Clinical ergotism is rarely observed and can affect all the arteries, especially of the inferior limbs. Vasospasm of the peripheral arteries and collateral formation are specific findings on angiography. We report the illustrative case of a 38 years old woman hospitalized for a small bowel occlusion. She suffers from chronic migraine treated by ergotamine tartrate. During her hospitalization, she develops an acute ischemia of the lower limbs. An ergotism was clinically suspected and confirmed by Duplex sonography which demonstrate multiple vasospasm. Under iv sodium nitroprusside and peridural analgesia the spasm resolved in 24 hours. The control Duplex sonography confirm the normality of the lower limb arteries. This examination modality allow a non-invasive diagnosis and evolution control of arteriospasm.

Adult↗
PubMed1977

Ischemic bowel disease attributable to ergot.

A 50-year-old woman developed ischemic colitis temporally related to ingestion of a large dose of ergotamine tartrate. The patient did not have cardiovascular, metabolic, or inflammatory conditions predisposing to bowel ischemia. To our knowledge, this is the first patient proved to have developed bowel ischemia secondary to ergot toxicity.

Colitis↗
PubMed1996

[Drug-induced pleurisy].

Drug induced pleurisy is often a diagnosis of elimination because the clinical presentation, paraclinical features and anatomicopathological aspect are relatively non-specific. The pleural effusions are typically chronic and somewhat torpid, most often bilateral but may be unilateral. Two types of lesion are found: effusion or thickening and these may be associated. The peculiarity of these pleural diseases are the frequent coexistence of accompanying signs: for example pulmonary, cutaneous, ocular, hepatic, peritoneal, pericardial as well as evidence of inflammation and depending on the medicaments hypereosinophilia, cytolysis, cholestasis or antinuclear antibodies. Anatomicopathogically there is dense fibrosis which is diffuse, pauci-cellular and with little inflammation. The progress is variable according to the drug either going on to complete regression on the cessation of the medication or the persistence of a degree of pleural thickening. The causative drugs are essentially the derivatives of Ergotamine and amongst others bromocryptine and dantrolene.

Bromocriptine↗
PubMed1997

Diagnosis and symptomatic treatment of migraine.

Migraine is a common, complex neurophysiologic headache disorder. Most migraineurs have neither been diagnosed by physicians nor effectively treated. The clinical diagnosis of migraine is based on headache characteristics and associated symptoms, particularly nausea and vomiting. Pharmacologic symptomatic treatment is aimed at reversing, aborting, or reducing pain and the accompanying symptoms of an attack. Individualization of therapy is essential in determining whether symptomatic and/or preventive treatment for migraine attacks are needed. The presence of nausea and vomiting must be considered in developing a treatment plan. The patient's priorities and preferences regarding therapy must be taken into account. The goals of symptomatic treatment are to relieve pain and the associated symptoms and to optimize the patient's ability to function normally. Multiple treatment strategies utilizing combinations of 5-hydroxytryptamine1 (5-HT1) agonists (ergotamine tartrate [ET], sumatriptan, and dihydroergotamine [DHE]) with simple analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and opiates provide effective treatment for most attacks of moderate to severe migraine. Treatment strategies are based on the frequency, nature, and severity of attacks. Patients with intractable, acute migraine may require hospitalization and aggressive parenteral treatment. Wider use of currently available diagnostic criteria and symptomatic medications should improve the diagnosis and treatment of migraine.

Affect↗