Alternatives to D.H.E. 45 If You Can't Fill Your Prescription

D.H.E. 45 (dihydroergotamine mesylate) has been in shortage since 2022, and many patients are finding it impossible to consistently fill their prescriptions. If you're one of them, the most important thing to know is this: you have options. Several effective medications treat acute migraine and cluster headaches — and with the right conversation with your prescriber, you can find a workable alternative while D.H.E. 45 supply remains uncertain.

This guide is not a substitute for medical advice. Always talk to your doctor or headache specialist before changing your migraine treatment plan.

Option 1: Other Dihydroergotamine Formulations

Before switching to a different drug class entirely, it's worth asking your doctor whether another DHE formulation could work for you. These contain the same active ingredient but are delivered differently:

Trudhesa (dihydroergotamine nasal spray, 0.725 mg/spray) — A higher-dose nasal spray by Impel that uses Precision Olfactory Delivery (POD) technology to deposit medication deeper in the nasal cavity for improved absorption. Distributed through specialty pharmacy networks.

Migranal (dihydroergotamine nasal spray, 0.5 mg/spray) — Generic versions are available and may have different supply availability than the injectable.

Brekiya (dihydroergotamine subcutaneous autoinjector) — FDA approved in 2025. Ready-to-use pen for self-injection; no refrigeration or priming required.

Option 2: Triptans

Triptans are the most commonly prescribed first-line acute migraine treatments. They work by activating serotonin 5-HT1B/1D receptors, similar to DHE, but are generally more selective (less vasoconstriction of peripheral vessels). Important note: do not take a triptan within 24 hours of using DHE, or vice versa.

Sumatriptan (Imitrex) — Available as oral tablets, nasal spray, and subcutaneous injection. The subcutaneous form works fastest and is effective for both migraine and cluster headaches. Widely available generic.

Zolmitriptan (Zomig) — Available as oral tablet and nasal spray. Nasal spray works well for patients with nausea.

Rizatriptan (Maxalt) — Fast-acting oral triptan; generic widely available.

Eletriptan (Relpax) — Longer duration of action; may have lower recurrence rate than shorter-acting triptans.

One key advantage of DHE over triptans is its lower headache recurrence rate. DHE's longer half-life means the headache is less likely to return after treatment. If you switch to triptans and notice more headache recurrence, tell your doctor.

Option 3: CGRP Receptor Antagonists (Gepants)

Gepants are a newer class of oral migraine medications that block calcitonin gene-related peptide (CGRP) receptors. They work without causing vasoconstriction, making them an option for patients who cannot use triptans or ergotamines due to cardiovascular risk factors.

Ubrogepant (Ubrelvy) — Oral tablet for acute migraine. Can be taken even if triptans were recently used (check with your doctor regarding timing). Does not cause vasoconstriction.

Rimegepant (Nurtec ODT) — Orally dissolving tablet; approved for both acute migraine treatment and prevention.

Option 4: Lasmiditan (Reyvow)

Lasmiditan (Reyvow) is a 5-HT1F receptor agonist (a "ditan"). Unlike triptans and DHE, it does not cause vasoconstriction, making it an option for patients with cardiovascular risk factors who need a vasoconstriction-free alternative. It is a Schedule V controlled substance and may impair driving.

38,224+ patients found their medications in stock

38K+

Find D.H.E. 45 In Stock Today →

Option 5: Ergotamine With Caffeine (Cafergot)

Ergotamine with caffeine (Cafergot) is an older ergot medication available as oral tablets or suppositories. It is in the same drug class as DHE but has a different side effect and tolerability profile. More likely to cause nausea and is not typically preferred over newer options, but can be useful when other medications are unavailable.

Special Considerations for Cluster Headache

DHE injectable is a particularly important medication for cluster headache, where fast and reliable treatment is critical. If you have cluster headaches and cannot find DHE:

Sumatriptan subcutaneous injection (6 mg) — This is the best-studied acute cluster headache treatment and is considered first-line.

High-flow oxygen therapy (100% O2, 7–10 L/min via non-rebreather mask) — Highly effective for aborting cluster attacks in 50–60% of patients; no medications required.

Zolmitriptan nasal spray (5–10 mg) — AHS guidelines support this as an acute cluster headache treatment.

Skip the calls, skip the stress.

Find D.H.E. 45 In Stock Today →

50K+

Medications
Found

99%

Success
Rate

6+

Hours saved
on average

What to Tell Your Doctor

When talking to your prescriber about alternatives, be specific: explain that D.H.E. 45 is consistently unavailable at your local pharmacies. Ask for a backup prescription alongside your DHE prescription, so you always have an option. You can also ask your doctor to work with a specialty pharmacy to source DHE. In the meantime, see our guide to finding D.H.E. 45 in stock near you — your pharmacy search doesn't have to be manual.