Prolonged Arteriospasm After Overdose of Oral Ergotamine Tartrate in Migraine

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Abstract
Severe arteriospastic disease in migraine is rare because ergotamine tartrate is used only from time to time and therefore vasoconstriction is intermittent. Such disease with gangrene and even death has been reported many times in other conditions and in the presence of contraindications[long dash]these being thyrotoxicosis, sepsis (especially puerperal fever), hepatic disease, renal disease, obliterative vascular disease, and cardiovascular disease (Von Storch, 1938). There are only 12 cases reported in the literature of prolonged arteriospasm due to the use of ergot preparations in migraine (Silfverskiold, 1947; Cleveland and King, 1948; Martinetti, 1949; Thompson, McClure, and Landowne, 1950; Peters and Horton, 1951 (3 cases); Fairbairn, 1958 (2 cases); Ellison, 1960 (overdose of suppositories); Young and Humphries, 1961; Allen, Barker, and Hines, 1962). In these cases the drug was administered either by injection or suppository or both. In none of them was amputation of a major limb a sequel to the arteriospasm. The case reported here followed a similar course to those cited above. There was severe arteriospasm both of large and small arteries in the upper and lower limbs, with recovery 48 hours after stopping the drug and starting treatment. There were contraindications to its use, but the patient developed tolerance to the drug with withdrawal headaches, and a vicious circle was set up (Wolfson and Graham, 1949; Peters and Horton, 1951; and Friedman, Brazil, and Von Storch, 1955). The dose of oral ergotamine tartrate should not exceed 8 mg for each attack or 24 mg a week, and the smallest possible dose should always be used.