What's the evidence for ergotamine drugs?

In this section
Ergotamine drugs compared with sumatriptan
Ergotamine drugs compared with aspirin
Ergotamine drugs compared with rizatriptan
Ergotamine drugs compared with eletriptan
Ergotamine drugs compared with naproxen

There is some evidence that drugs based on ergotamine can relieve migraine headaches.

One big summary of the evidence (known as a systematic review) showed that ergotamine drugs were better than dummy tablets (placebos) at helping people who had migraines.¹ Ergotamine made people's headaches less severe, reducing them from moderately or severely bad to mild. And ergotamine helped some people's headaches go away completely.

The review included seven studies known as randomised controlled trials (RCTs). But none of these studies used the definition of migraine drawn up by a group of experts called the International Headache Society. This makes their results less reliable since we do not know for sure if all the people in the studies actually had migraine attacks or some other type of headache.

We also looked at other studies on ergotamine drugs. Here's what they found.

Ergotamine drugs compared with sumatriptan

A good-quality study (a randomised controlled trial) compared ergotamine with another drug often used to treat migraine attacks (sumatriptan) and with a placebo.² The study looked at 368 patients.

Patients used one of three treatments: a nasal spray with 1 milligram (mg) of ergotamine in it, a nasal spray with 20 mg of sumatriptan in it or a placebo treatment. (Ergotamine isn't available as a nasal spray in the UK.)

• An hour after using the spray, more people who used sumatriptan than people using ergotamine felt that their pain was better.
• But people who used sumatriptan and people who used ergotamine had the same amount of vomiting, sensitivity to light and sound, and other symptoms.
• Also, the side effects seemed to be similar with both treatments.

A further good-quality study of 580 people compared 2 mg of an ergotamine drug plus caffeine with 100 mg of sumatriptan.³ It found that ergotamine plus caffeine didn't work as well as sumatriptan did.

Ergotamine drugs compared with aspirin

One small study of 250 people compared ergotamine plus caffeine with aspirin plus a drug to stop you feeling sick (called metoclopramide).⁴ More people who took aspirin plus metoclopramide felt better than people who took ergotamine plus caffeine. And more people who took aspirin plus metoclopramide no longer had nausea and vomiting after two hours.

Ergotamine drugs compared with rizatriptan

A study with 439 people compared ergotamine taken with caffeine with a treatment called rizatriptan.⁵ In this study, patients tried one treatment for a first migraine attack and then the other treatment for a second attack (this is called a crossover trial).

The study found that rizatriptan worked better than ergotamine plus caffeine both for headache relief and for reducing the nausea and vomiting some people get with migraine attacks.

Ergotamine drugs compared with eletriptan

One study of 733 people compared ergotamine plus caffeine with a treatment called eletriptan.⁶ It found that both 40 mg and 80 mg of eletriptan were better for headache relief than ergotamine plus caffeine.

Two hours after treatment, slightly more than half of those taking 40 mg of eletriptan were better and slightly more than two-thirds of those taking 80 mg were better. Only one-third of people taking ergotamine felt better after two hours.

Ergotamine drugs compared with naproxen

Two studies found that a treatment called naproxen worked better than ergotamine.^{7 8} But nearly half the people withdrew from one of these studies before the end, so its results aren't reliable.⁸

Another study found no difference between ergotamine and naproxen.⁹

For more details:

Read this information about the treatment in Clinical Evidence