Intravenous dihydroergotamine (DHE) is a relatively underutilized medication with a plethora of supportive clinical evidence for its use in persons with numerous headache disorders. It is effective for acute migraines, status migranosus, chronic migraines, medication overuse headaches, and cluster headaches. Given the high prevalence of these conditions and their associations with disability and significant healthcare burdens, DHE may be an appropriate medication for many people with these ailments, if reasonable and clinically relevant. Not only has it been found to be comparable or superior to many standard of care treatments, but DHE is also relatively well tolerated with generally a low prevalence of severe adverse risks. However, DHE is not entirely innocuous; it has an adverse effect profile that includes myocardial, cerebral, or peripheral limb ischemic or infarction. Consequently, the appropriate clinical measures must be undertaken to risk-stratify DHE candidates and monitor those receiving the medication appropriately.