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Pronounced: MY-grah-nal
Generic name: Dihydroergotamine mesylate

Why is this drug prescribed: Migranal Nasal Spray is used for relief of migraine headache attacks, whether or not preceded by an aura (visual disturbances, usually including sensations of halos or flickering lights). This nasally administered remedy contains the same active ingredient as D.H.E. 45, an injectable form of the drug. It constricts the blood vessels, and may defeat migraine through this action.

Most important fact about this drug: Migranal Nasal Spray is for use only during a genuine attack of classic migraine. Do not attempt to prevent migraines with this drug, and do not use it for tension headaches, cluster headaches, or unusual types of migraine such as hemiplegic or basilar migraine.

How should you take this medication: Migranal comes in single-dose ampuls, each with an accompanying nasal sprayer. Do not open an ampul until needed. Once opened, the drug must be used within 8 hours to be fully effective. Take this medication at the first sign of a developing migraine. Assemble the ampul and sprayer according to package directions, pump the sprayer 4 times to prime it with medication, then spray once in each nostril. While spraying, do NOT tilt your head back or inhale through your nose. Wait 15 minutes, then spray once in each nostril again. After the second spray, discard the sprayer and the ampul's cap. To be prepared for the next attack, remember to load a new ampul and sprayer into the assembly case that comes with the medication. Migranal will be effective even if you have a stuffy nose, a cold, or allergies. --If you miss a dose... Migranal Nasal Spray is not for regular use. Use it only during a migraine attack. --Storage instructions... Store at room temperature away from heat and light. Do not refrigerate or freeze.

What side effects may occur: Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue using Migranal Nasal Spray. More common side effects may include: Altered sense of taste, dizziness, drowsiness, nasal inflammation, nausea, sore throat, vomiting Less common side effects may include: Diarrhea, dry mouth, fatigue, hot flushes, loss of strength, sinus inflammation, stiffness, tingling sensation Rare side effects may include: Abdominal pain, altered sense of smell, cold clammy skin, confusion, conjunctivitis (pinkeye), cramps, decreased sensation, difficulty breathing, difficulty swallowing, earache, ear ringing, excessive muscle tone, feeling cold or ill, feeling of well-being, fever, hiccups, increased urination, increased sweating, impaired concentration, indigestion, insomnia, intolerance to light, itching, lack of muscle tone, loss of voice, muscle aches, muscle weakness, nervousness, rapid or throbbing heartbeat, rash, red/purple blotches on the skin, respiratory tract infection, swelling, tearing abnormalities, tremor, vision abnormalities, yawning

Why should this drug not be prescribed: Do not take Migranal if you have ever had an allergic reaction to an ergotamine-based drug such as the migraine remedies Cafergot, Ergostat, and D.H.E. 45 Injection, or the senility drug Hydergine. You should avoid Migranal if you have certain types of heart or blood vessel disease, including angina (crushing chest pain) or a history of heart attack, or if you suffer from uncontrolled high blood pressure, severe kidney or liver disease, or a severe blood infection. Avoid it, too, if you have recently had blood vessel surgery. Do not use Migranal within 24 hours of taking another ergotamine-based drug, another migraine remedy such as Amerge, Imitrex, Maxalt, or Zomig, or the migraine-preventing drug Sansert. Also avoid combining Migranal with other drugs that constrict the blood vessels, such as the decongestants pseudoephedrine and phenylpropanolamine found in many over-the-counter cold products. Do not use Migranal Nasal Spray while pregnant or nursing.

Special warnings about this medication: If you have heart disease, Migranal could trigger a serious problem. Risk factors for this disorder include high blood pressure, high cholesterol, diabetes, a family history of heart disease, smoking, and passing menopause. Your doctor will probably want to observe your reaction to the first dose of Migranal if any of these factors apply. Because Migranal constricts blood vessels, you should use it with caution if you have circulation problems in your arms, legs, fingers, or toes. Use it cautiously, too, if you are being treated for high blood pressure; it occasionally aggravates the problem. Alert your doctor immediately if you have any of the following side effects: pain in the arms and legs, numbness or tingling in your fingers or toes, coldness, pallor, weakness in the legs, chest pain, temporary speeding or slowing of the heart rate, swelling, itching, or a bluish color in your fingers and toes.

Possible food and drug interactions when taking this medication: If Migranal is taken with certain other drugs, the effects of either can be increased, decreased, or altered. Completely avoid other migraine remedies and ergotamine-based drugs, and check with your doctor before combining Migranal with the following: Azithromycin (Zithromax) Clarithromycin (Biaxin) Erythromycin (Ery-Tab, Eryc) Nicotine (from any source, including cigarettes, patches, or inhalers) Phenylpropanolamine (Propagest) Propranolol (Inderal) Pseudoephedrine (Afrin, Sudafed) Troleandomycin (Tao)

Special information if you are pregnant or breastfeeding: Migranal can harm a developing baby; do not use it during pregnancy. Also avoid while breastfeeding. It appears in breast milk and may cause diarrhea, vomiting, weak pulse, and unstable blood pressure in a nursing infant.

Recommended dosage: Use one spray (0.5 milligram) in each nostril followed by another spray in each nostril 15 minutes later for a total of 4 sprays (2 milligrams). Do not use more than 3 milligrams (6 sprays) in 24 hours or 4 milligrams (8 sprays) in 7 days.

Overdosage: Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately. Symptoms of Migranal overdose may include: Abdominal pain, abnormal speech, coma, confusion, convulsions, hallucinations, increase and/or decrease in blood pressure, nausea, numbness, tingling, pain, and a bluish color of your fingers and toes, slowed breathing, vomiting

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