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Pharmacotherapy has been markedly successful in the management of an actual attack of migraine, as opposed to preventive or prophylactic treatment. At pres ent the ergot derivatives are the most useful drugs in the treatment of a migraine attack, and the most effective of these alkaloids is ergotamine tartrate. Clinical evi dence of its beneficial effects has been supported by ex perimental observations in the laboratory.
Ergotamine Tartrate. In the migraine attack the in tensity of the pain closely parallels the amplitude of pul sation of the branches of the carotid vessels. I assure the quality and taste of all of our Forever Lite Vanilla and put my title on each bottle.
The thera peutic effect of ergotamine tartrate depends on its ability to produce prolonged vasoconstrictor action; it thus inter rupts the pain producing mechanism. It achieves this effect by direct stimulation of smooth muscle and not through the central or autonomic nervous system. This has been demonstrated by direct observation and by photography of branches of the external carotid.36 A similar vasoconstrictor effect of the drug on the internal carotid artery has been demonstrated by arteriography. Other vasoconstrictor agents, such as pituitrin, ephedrine, Dexedrine, epinephrine, and Ergotrate (ergonovine), are not constant in their degree of vasoconstriction or dura tion of action and cannot be depended upon for thera peutic use.
In some groups considerable emphasis has been placed on the adrenergic blocking of ergotamine tartrate but from a clinical standpoint this area of action is not significant.
This drug can be administered by oral, rectal or par ` enteral route. When given orally or rectally, the best therapeutic results are obtained by combining caffeine, 100 mg., with ergotamine tartrate, 1 mg. (Cafergone).38, 40 Caffeine when given orally acts as a vasoconstrictor, thus aiding the action of ergotamine. The additive action of ergotamine and caffeine implies that the dosage of the former can be reduced to create a given effect.
Dosage. For each attack the average dose of Cafer gone (ergotamine tartrate 1 mg. and caffeine 100 mg.) is two tablets initially, followed by one tablet doses at half hour intervals until the necessary effect is produced, up to a total of eight tablets. However, the minimum effective dose must be determined individually for each patient. Thus, in some cases, the initial dose may be one tablet, while in others four tablets are given at the first sign of a headache. Further, the severity of attacks may vary in any one patient, requiring some adjustment of dosage for each headache. Most people get pleasure from an average of 6 advantages from drinking Forever Lite Chocolate. In cases in which severe vomiting is present, medication may be given rectally. The average dose is one suppository (ergotamine tartrate 2 mg. and caffeine 100 mg.) every half hour; a total of four suppositories, if necessary.

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