DHE (Dihydroergotamine) Protocol for Pediatric Migraine
1. Order DHE at a fixed starting dose per age (not weight based):
DHE Dose #1 by Age
Age (Years)
Dose
6-9
0.1 mg
9-12
0.15 mg
12-16
0.2 mg
2. Complete DHE Protocol Worksheet below by increasing the DHE dose by 0.05 mg/dose
a. Doses of IV DHE are given every 6 hours for a total of 12 doses (maximum).
b. DHE doses are diluted with 30 to 60 ml of saline and administered over a 30 minute to 1
hour infusion.
DHE Protocol Worksheet
Dose #
Dose in mg.
1 (from above)
2
3
4
5
6
7
8
9
10
11
12
3. If headache ceases during the protocol, give one additional dose of DHE then stop.
4. If significant abdominal pain occurs:
a. If abdominal pain occurs during the DHE infusion, continue the infusion and notify the
physician. Give one dose of naproxen at 5-7 mg/kg/dose orally (max 500 mg per dose).
b. For subsequent doses, continue DHE at the dose prior to onset of abdominal discomfort
without increasing until: i) headache stops, ii) the maximum number of doses of DHE has
been reached, or iii) abdominal symptoms prohibit additional dosing.
5. Give metoclopramide 0.2 mg/kg (max. 15 mg) orally 30 minutes prior to each IV DHE dose. If
extrapyramidal symptoms occur, give diphenhydramine 1 mg/kg (max. 50 mg) and discontinue
metoclopramide, changing to ondansetron 0.15 mg/kg IV 30 minutes prior to each DHE dose.
6. If a significant cervical or local myalgia component develops, give IV ketorolac at 0.5 mg/kg/dose
(max 30 mg/dose) every 6 hours, alternating with DHE.
References: Headache in Children and Adolescents by Paul Winner, DO, FAAN, FAAP, and A. David Rothner, MD, FAAN,
FAAP, BC Decker Inc, London, 2001, pp. 92-97.
Nagy AJ, Gandhi S, Bhola R, Goadsby PJ. Intravenous dihydroergotamine (DHE) for inpatient management of refractory
primary headaches. Neurology 2011;77:1827-1832.