Ergotism causing peripheral arterial occlusion in the hand

Ergotamine is used today for the symptomatic treatment of migraine. It is known that the intake of ergotamine-containing medicaments in cases of migraine causes disturbance of the blood-flow to the peripheral arteries of the extremities. Most of these spastic occlusions are due to medicaments containing ergotamine tartrate. Thus, ergotism is one of the frequent causes of spastic occlusion. The symptoms of blood-flow disturbances due to ergotamines do not differ from other geneses. Extreme cases develop gangrene of the finger tips, leading to a wrong diagnosis and subsequent amputation. A careful history and arteriography showing smooth stenoses usually give the correct diagnosis. An antidote to ergotamine is not known but the spastic occlusion and the neuropsychiatric complications are usually gone some days after the ergotamine-containing substance is discontinued. Anticoagulants and low-molecular dextran are indicated in order to prevent irreversible thrombosis.