Lower extremity ischemia due to combined drug therapy for migraine

Ergot induced peripheral vascular insufficiency, non-interventional treatment

We report a case of ergotamine tartrate induced severe vasospasm in the renal arteries and the arteries of the lower extremities. Classic features seen on peripheral angiography make the diagnosis. Anticoagulation, thrombolysis, vasodilation, steroids, and prostaglandin inhibitors all have been successfully used to treat symptomatic ergot induced arterial vasospasm. Although balloon angioplasty of ergot induced vasospasm has been described in case reports, ergot vasospasm is a self limited and medically treatable condition that does not require peripheral mechanical intervention, unless the immediate threat of necrosis and gangrene exists.

Successful limb salvage with prostaglandin infusion: a review of ergotamine toxicity

OBJECTIVE

A case of severe acute peripheral arterial insufficiency secondary to ergotamine toxicity treated successfully with intravenously administered prostaglandin is presented to highlight the features of this condition and to demonstrate the efficacy of treatment with prostaglandin infusion.

CLINICAL FEATURES

A 35-year-old unemployed Caucasian woman with a background of polypharmacy abuse and recurrent migraines presented to St Vincent's Hospital Emergency Department with limb-threatening ischaemia of both legs secondary to chronic ergotamine overuse.

INTERVENTION AND OUTCOME

A prostaglandin infusion was started and a dramatic and rapid improvement of her peripheral circulation occurred within six hours.

CONCLUSION

Ergotamine toxicity is an uncommon but well documented cause of peripheral vascular insufficiency that should be recognised and treated aggressively because its sequelae can be disastrous. Intravenously administered prostaglandin proved to be successful in this case and is a logical choice as first-line therapy for ergotamine toxicity.