A Study Examining the Use of a Migraine Medicine in the Treatment of Two Migraine Attacks in Patients Who Have Increased Skin Sensitivity

An Open Label Pilot Trial to Collect and Evaluate Data on the Use of Dihydroergotamine Mesylate in the Treatment of Two Migraine Attacks Associated With Cutaneous Allodynia

This is a research study examining a migraine medicine dihydroergotamine mesylate (DHE-45).It will be used to treat two migraine attacks in subjects who have a history of skin sensitivity associated with their headaches.This skin sensitivity is called cutaneous allodynia (pronounced q-tay-nee-us al-o-din-ee-uh).Cutaneous allodynia is a sensation of pain when a non-noxious stimulus is applied to normal skin. It has been noted in several studies that in subjects with migraine, seventy nine percent of the subjects experienced allodynia on the facial skin on the same side as the headache. It has also been shown that that once allodynia develops, other migraine medicines that would normally be very effective for migraine pain, become much less effective or ineffective. This study will compare the differences,if any, in attacks treated early with this study drug and treated later with the same study drug. It is hoped that that this trial will provide information on the use of DHE-45 in subjects who have cutaneous allodynia. Understanding more about allodynia may help us understand how the pain system works in migraine.

Inclusion Criteria:

• Male and female subjects between the ages of 18 and 65, inclusive
• Subjects diagnosed with episodic migraine, with or without aura according to International Headache Criteria (IHS) (Appendix B) for at least one-year prior to screening
• Subjects who experience between 3-10 migraine attacks per month (during the previous 6 months) with no more than 15 days of headache per month.
• Subjects who report their migraine pain quality as pulsating/ throbbing.
• Subject is using or agrees to use for the duration of participation a medically acceptable form of contraception (as determined by investigator), if female of child-bearing potential
• Subjects who are able to come for 2-hour in-clinic treatment of two separate migraine attacks
• Subjects who are able to understand and comply with all study procedures.
• Subject provides written informed consent prior to any screening procedures being conducted

Exclusion Criteria:

• Pregnant and/or lactating women
• Subjects who, in the investigators opinion, have a history or have evidence of a medical or psychiatric condition that would expose them to an increased risk of a significant adverse event or would interfere with the assessments of efficacy and tolerability during this trial
• Subjects with an abnormal ECG that, in the investigators opinion, would expose them to increased risk of adverse events or interfere with study drug and/or analysis of efficacy/tolerability
• Subjects currently using, or expecting to use during the trial, Cytochrome P450 3A4 (CYP3A4 enzymes) inhibitors (such as protease inhibitors and macrolide antibiotics)
• Subjects with severely impaired hepatic or renal function, as determined by the investigator
• Subjects who have participated in an investigational drug trial in the 30 days prior to the screening visit
• Subjects who currently have or have a history of basilar or hemiplegic migraine
• Subjects who have previously shown hypersensitivity to ergot alkaloids
• Subjects who have a history of non-response to DHE-45, as determined by investigator
• Subjects with uncontrolled hypertension
• Subjects who currently have or who have a history of ischemia and/or vasospastic coronary artery disease
• Subjects who, in the investigators opinion, have significant risk factors of coronary artery disease