Methysergide

Brand names

• Sansert

Usage

Used to prevent vascular headaches (those that occur in response to changes in normal blood flow within the blood vessels in the brain), such as migraines and cluster headaches. Because of the possible risk of serious, irreversible side effects, methysergide is prescribed only as a last resort for patients with frequent or disabling headaches who are unresponsive to other treatments. This medication is not useful against tension headaches or a vascular headache that has already started.

How it works

The exact mechanism of action is unknown, although it appears that methysergide eases vascular headaches by causing constriction of the blood vessels in the brain. It is also believed to block the effects of serotonin, a chemical messenger in the nervous system associated with vascular headaches.

Side effects

Serious

Chest pain or tightness; shortness of breath; extreme dizziness; difficult or painful urination; large increase or decrease in urine output; pain in the arms, legs, groin, lower back, or side; swelling of hands, ankles, feet, or lower legs; fever or chills; pale or cold hands or feet; hallucinations. Get medical help right away. Contact your doctor as soon as possible if you experience abdominal pain; itching; numbness or tingling of fingers, toes, or face; or weakness in the legs.

Common

Diarrhea; mild dizziness or lightheadedness, particularly upon arising from a lying or sitting position; drowsiness; nausea; vomiting.

Less common

Vision changes, loss of coordination, rapid or slow heartbeat, cough or hoarseness, loss of appetite or weight, raised red spots on your skin, redness or flushing of the face, skin rash.

Possible interactions

Other medicaments:

Methysergide taken concurrently with:

• beta-blocker medicaments may cause hazardous constriction of peripheral arteries; watch combined effects on circulation in the extremities.
• efavirenz (Sustiva) increases risk of methysergide toxicity.
• medicines removed by the cytochrome P450 3A4 enzymes as well as those that inhibit CYP 3A4 may lead to methysergide toxicity. Medicines that increase CYP3A4 will blunt methysergide benefits.
• sibutramine (Meridia) increases serotonin syndrome risk.
• sildenafil (Viagra) may increase risk of methysergide toxicity.
• sumatriptan (Imitrex) and other triptans, such as naratriptan, zolmitriptan or rizatriptan, may cause prolonged spasm of blood vessels.

Foods:

No restrictions except foods you are allergic to. Some vascular headaches are due to food allergy, or have specific food triggers. A headache diary can help you identify triggers and then avoid them.

Herbal medicines or minerals:

Since methysergide and St. John's wort may act on serotonin, the combination is not advised. Using ma huang or ephedrine-like compounds may result in additive and undesirable vasoconstriction. If you are allergic to plants in the Asteraceae family (aster; chrysanthemum, daisy or ragweed), you may also be allergic to Echinacea, chamomile, feverfew and St. John's wort. St. John's wort can cause changes in the liver enzymes that help remove this medicine-talk to your doctor before combining any herbal medicine or mineral with methysergide.

Exposure to cold:

Cold environments may increase the occurrence of reduced circulation (blood flow) to the extremities.

Discontinuation:

Do not stop it abruptly if medicament has been taken for a long time. Slowly lowering the dose over 2 to 3 weeks can prevent rebound vascular headaches.

Comments