Dihydroergotamine nasal is used to treat migraine headaches with or without aura in adults. Dihydroergotamine nasal will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.

Dihydroergotamine nasal should not be used to treat any headache that seems to be different from your usual migraine headaches.

Dihydroergotamine nasal may also be used for purposes not listed in this medication guide.

You should not use dihydroergotamine if you are allergic to it or similar medicines (ergotamine, ergonovine, methylergonovine, and others), or if you have or have ever had:

• heart disease, angina (chest pain), blood circulation problems, coronary artery disease (clogged arteries), or a heart attack or stroke;
• uncontrolled high blood pressure;
• a serious infection called sepsis;
• vascular surgery;
• narrowing of blood vessels in the legs, arms, stomach, or kidneys (peripheral vascular disease); or
• severe liver or kidney disease.

Some drugs should not be used with dihydroergotamine. Your treatment plan may change if you also use:

• medicines that raise your blood pressure or constrict your blood vessels;
• an antibiotic such as troleandomycin, clarithromycin, or erythromycin;
• antifungal medicine such as itraconazole or ketoconazole; or
• antiviral medicine for HIV or hepatitis C.

Tell your doctor if you have ever had:

• blood circulation problems in your arms, hands, legs, or feet;
• chest pain, shortness of breath;
• risk factors for coronary artery disease (high blood pressure, high cholesterol, diabetes, menopause, smoking, family history of coronary artery disease, being overweight, being over 40 and a man); or
• liver or kidney disease.

Dihydroergotamine may cause preterm labor. Tell your doctor if you are pregnant or plan to become pregnant. Do not use this medicine if you are pregnant.

Do not breastfeed while using this medicine, and for at least 3 days after your last dose.

Use Migranal (Dihydroergotamine Injection) exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• numbness, cold feeling, or pale appearance of your fingers or toes;
• sudden or severe stomach pain, weight loss, nausea, vomiting, constipation, bloody diarrhea, fever;
• severe headache, blurred vision, pounding in your neck or ears;
• burning sensation in the nose, mouth, throat, and altered sense of taste;
• fast or slow heart rate;
• swelling or itching;
• signs of a blood clot--sudden numbness or weakness on one side of the body, chest pain, problems with vision or speech, pain or swelling in one leg; or
• heart attack symptoms--chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating.

Common side effects may include:

• pain, bruising, swelling, or irritation where the medicine was applied;
• drowsiness;
• dizziness;
• nausea, vomiting, diarrhea;
• runny nose;
• altered sense of taste; or
• sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Do not use dihydroergotamine nasal within 24 hours before or after using another migraine headache medicine, including:

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Grapefruit may interact with dihydroergotamine nasal and cause side effects. Avoid consuming grapefruit products.