What Is D.H.E. 45? Uses, Dosage, and What You Need to Know in 2026

D.H.E. 45 is the brand name for dihydroergotamine mesylate injection — an injectable medication that has been treating severe migraines and cluster headaches since it was first FDA-approved in 1946. Despite the discontinuation of the original brand by Bausch Health in 2022, generic dihydroergotamine mesylate injection remains available and is one of the most potent acute treatments for migraine available to patients today.

What Is D.H.E. 45?

D.H.E. 45 (dihydroergotamine mesylate) is an ergot alkaloid belonging to the antimigraine drug class. It is available as a clear, colorless sterile solution containing 1 mg of dihydroergotamine mesylate per mL, supplied in sterile ampules for intravenous (IV), intramuscular (IM), or subcutaneous (SC) injection.

The "45" in D.H.E. 45 refers to 45 micrograms — the original unit characterization of the product's activity. Today, the drug is standardized at 1 mg/mL.

What Is D.H.E. 45 Used For?

D.H.E. 45 has two FDA-approved indications:

Acute treatment of migraine headaches with or without aura — DHE is particularly useful for moderate-to-severe migraine attacks, especially when oral medications are ineffective due to nausea and vomiting, or when faster onset is needed.

Acute treatment of cluster headache episodes — Cluster headaches are among the most painful headache disorders; DHE injectable provides fast relief.

Off-label, IV DHE is used in inpatient settings for status migrainosus (prolonged, intractable migraine lasting more than 72 hours) and for other refractory headache disorders that have not responded to outpatient therapy.

Important: D.H.E. 45 is not used for migraine prevention. It is an acute, episodic treatment only.

D.H.E. 45 Dosage and How to Use It

D.H.E. 45 injection is administered as 1 mL (1 mg) per dose. The route of administration depends on your prescriber's instructions and your clinical situation:

Intramuscular (IM) or Subcutaneous (SC) — 1 mg; repeat every 1 hour as needed; maximum 3 mg per 24 hours; maximum 6 mg per week.

Intravenous (IV) — 1 mg; repeat every 1 hour as needed; maximum 2 mg per 24 hours; maximum 6 mg per week.

D.H.E. 45 should not be used for chronic daily administration. It is indicated for episodic acute attacks — not daily or near-daily use.

Other Forms of Dihydroergotamine (DHE)

The same active ingredient (dihydroergotamine mesylate) is available in several other formulations:

Migranal nasal spray (0.5 mg/spray) — Generic available; 1 spray per nostril initially, repeated after 15 min; max 2 mg/dose.

Trudhesa nasal spray (0.725 mg/spray) — Higher-dose brand nasal spray; uses Precision Olfactory Delivery (POD) for enhanced absorption.

Brekiya subcutaneous autoinjector (1 mg) — FDA approved 2025; prefilled pen for self-injection without refrigeration or priming.

Atzumi nasal powder — FDA approved 2025; nasal powder delivery option.

38,224+ patients found their medications in stock

38K+

Find D.H.E. 45 In Stock Today →

Who Should Not Use D.H.E. 45?

D.H.E. 45 is contraindicated in patients with:

Ischemic heart disease, history of myocardial infarction, or documented silent ischemia

Coronary artery vasospasm or Prinzmetal variant angina

Uncontrolled hypertension

Peripheral arterial disease

Pregnancy (Pregnancy Category X) or breastfeeding

Concomitant use of strong CYP3A4 inhibitors (certain antibiotics, antifungals, HIV medications)

Within 24 hours of triptan or other ergotamine use

How Much Does D.H.E. 45 Cost?

Cash prices for the generic injectable range from approximately $262 to $733 for a standard supply (5–10 mL ampules), depending on quantity and pharmacy. GoodRx and similar discount services can bring prices down significantly. Insurance typically covers generic DHE under Part D and commercial plans, usually at Tier 2 or 3 copays.

For more on saving money, see our guide to saving money on D.H.E. 45. If you're struggling to find it at your pharmacy, medfinder can help you locate which pharmacies near you have it in stock.