Trials of an inhaled version of an old migraine drug show surprisingly good results.  The drug is dihydroergotamine and in injectable from is considered to be one of the strongest migraine medications.  It is often used intravenously to treat severe migraines that do not respond to other therapies and for medication overuse headaches.  It can be also injected into the muscle, under the skin or sprayed into the nose.  The main problem with this drug is that it often makes nausea worse or even causes severe nausea in patient who do not have it.  What is surprising about the new product being developed by MAP Pharmaceuticals (to be called Levadex if and when FDA approves it) is not that is is very effective, but that it causes significantly less nausea than the same drug in an injectable form.  Another advantage is that inhaling the medicine into the lungs results in a very quick delivery of the drug into the circulation – as quick as an injection but without a needle.  A similar product, Ergotamine Medihaler was available until about 15 years ago, but was withdrawn because of manufacturing difficulties and limited demand.  The demand for this new product will also be limited because it will be more expensive than a tablet of any migriane drug, it will be more bulky to carry around, and will be mostly utilized by patients who cannot take oral medications due to nausea or by those who need very quick onset of action to abort an attack.