I am a 55 year old male who has had type 1 diabetes for 10 years, and I also have frequent migraine attacks, for which the only effective drug is ergotamine. Is ergotamine a safe drug for people with diabetes? I wonder because it is vasoconstrictor. Are the very small blood vessels also constricted? This would seem to me to be undesirable, particularly as during an attack my blood glucose level is often very high and difficult to control.

It is true that ergotamine derivatives cause vasoconstriction. On the other hand, you see happens to your blood sugars when you have a headache. This may be a result of the pain, rather than the medication.

There are some medications which have been used as a prophylaxis for migraines. These medications include calcium channel blockers and beta blockers, which have some interaction with diabetes but do not have to be detrimental if monitored closely.

Whether ergotamine derivatives worsen microvascular complications of diabetes is unclear. It would be reasonable to speak with someone with expertise in headache pain to see if there is a medication you can take with favorable side effect profile and proven efficacy.

JTL