After taking some drug for acute attack of migraine, a patient developed nausea and vomiting. He also developed tingling and numbness on the tip of the finger that also turned blue. Which of the following is the most likely drug implicated in causing the above findings?

This is a classical sign of ergot induced vasoconstriction. Dihydroergotamine can be used for acute attack of migraine and can result in these symptoms. Due to their vasoconstricing potential, ergot alkaloids are contra-indicated in a patient with peripheral vascular disease. These may also lead to development of gangrene. Contraindications for ergotamine : Peripheral vascular disease Coronary aery disease Uncontrolled hypeension Fever and/or sepsis Pregnancy Within 24 hours of using triptans