They've run a ton of crap through that little IV. Saline. Methylprednisilone. Reglan. Benadryl. Depakote. And finally, this afternoon, DHE.
They had considerable trepidation about using this drug.
Dihydroergotamine is an derived from an old, old drug. Ergot alkaloids have been in use since the cavemen discovered them in fungi growing on rye seeds (http://en.wikipedia.org/wiki/Ergot). Historically they were used to induce labor, and to treat severe headaches. Because the sumatriptan caused her to have chest pain, and ergot can cause similar side effects for similar (frightening) reasons, there were concerns that there might be some underlying cardiac issues (oh for the love of all that's holy look at the kid's chart! she's had TWO full negative cardiac workups in less than 3 years, the last less than 6 months ago), so they had to call cardiology. Nephrology had already cleared the drug, so once we got the final go ahead, they put it up.
Within an hour she was headache free. The sunglasses are off, the lights are on, and she's getting restless and actually having conversations. They are hanging another dose at midnight, and reassessing the situation in the morning.
Headache free is a blessing. It isn't out of the woods, exactly, but it's a good start.
PS Oh, and the medical student did manage to make a fool of himself on rounds. I did my best not to point it out but the attending neurologist was not so kind, poor kid. Ah, I do not miss those days at all.