Make the Most of MIGRANAL


The acronym RAPID is a simple way to remember the correct steps for preparing and administering MIGRANAL1:

RRemove the cover and stopper from the vial
AAttach the pump
PPump to prime
IInitiate treatment
DDiscard after use

It is important to tell patients, DO NOT1:

  • Assemble the nasal spray pump until the time of use. Once it has been opened, it must be discarded after 8 hours
  • Sniff MIGRANAL after spraying into each nostril. MIGRANAL should remain in the nose so that it can be absorbed into the bloodstream through the lining of the nose

Steps for Administration

A step-by-step video demonstration of the preparation and administration of MIGRANAL.

Printable Instructions
for Patients

A quick guide to the simple steps for preparing and administering MIGRANAL.

Kit Includes:

  • 8 nasal spray vials*
  • 8 nasal sprayers

*Note: Each vial contains enough active ingredient
for priming and to deliver 4 total sprays as one dose.

  1. MIGRANAL [package insert]. Bridgewater, NJ: Bausch Health Companies Inc.

MIGRANAL® (dihydroergotamine mesylate) Nasal Spray is indicated for the acute treatment of migraine headaches with or without aura. MIGRANAL Nasal Spray is not intended for the prophylactic therapy of migraine or for the management of hemiplegic or basilar migraine.



Serious and/or life-threatening peripheral ischemia has been associated with the coadministration of DIHYDROERGOTAMINE with potent CYP3A4 inhibitors including protease inhibitors and macrolide antibiotics. Because CYP3A4 inhibition elevates the serum levels of DIHYDROERGOTAMINE, the risk for vasospasm leading to cerebral ischemia and/or ischemia of the extremities is increased. Hence, concomitant use of these medications is contraindicated.

  • MIGRANAL Nasal Spray should not be given to patients with ischemic heart disease (angina pectoris, history of myocardial infarction, or documented silent ischemia) or to patients who have clinical symptoms or findings consistent with coronary artery vasospasm, including Prinzmetal's variant angina.
  • MIGRANAL Nasal Spray also should not be given to patients with uncontrolled hypertension, or patients who have used 5-HT1 agonists, ergotamine-containing or ergot-type medications, or methysergide within the last 24 hours.
  • MIGRANAL Nasal Spray should not be administered to patients with hemiplegic or basilar migraine.
  • MIGRANAL Nasal Spray is also contraindicated in patients with known peripheral arterial disease, sepsis, following vascular surgery, and severely impaired hepatic or renal function.
  • MIGRANAL Nasal Spray may cause fetal harm and possesses oxytocic properties and therefore, should not be administered to pregnant women and should not be used by nursing mothers.
  • MIGRANAL Nasal Spray is contraindicated in patients who have previously shown hypersensitivity to ergot alkaloids.
  • MIGRANAL Nasal Spray should not be used with peripheral and central vasoconstrictors because the combination may result in additive or synergistic elevation of blood pressure.
  • MIGRANAL Nasal Spray should be used only where a clear diagnosis of migraine headache has been established.
  • MIGRANAL should not be used by patients with documented ischemic or vasospastic coronary artery disease. MIGRANAL should not be administered unless a cardiovascular evaluation provides satisfactory clinical evidence that a patient with risk factors (e.g., hypertension, hypercholesterolemia, smoker, obesity, diabetes, strong family history of CAD, females who are surgically or physiologically postmenopausal, or males who are over 40 years of age) is reasonably free of unrecognized coronary artery disease (CAD). Even for patients with a satisfactory cardiovascular evaluation, it is strongly recommended that administration of the first dose of MIGRANAL take place in the setting of a medically staffed facility.
  • During clinical studies and the foreign post-marketing experience with MIGRANAL Nasal Spray, there have been no fatalities due to cardiac events. Serious cardiac events, including some that have been fatal, have occurred following use of dihydroergotamine mesylate injection, but are extremely rare.
  • The most commonly reported adverse events in clinical trials for MIGRANAL Nasal Spray were rhinitis, altered sense of taste, application site reactions, dizziness, nausea, and vomiting. Adverse events associated with discontinuation were rhinitis, dizziness, facial edema, cold sweats, accidental trauma, depression, elective surgery, somnolence, allergy, vomiting, hypotension, and paresthesia.

To report SUSPECTED ADVERSE REACTIONS, contact Bausch Health US, LLC at 1-800-321-4576 or FDA at 1-800-FDA-1088 or

Please click here for full Prescribing Information for MIGRANAL Nasal Spray, including Boxed Warning and Patient Information.