Ergotamine has been associated with numerous vascular complications but only rarely with fibrosing disorders or valvular heart disease. Two patients are described in whom severe valvular dysfunction developed during ergotamine therapy for migraine headache. The surgically excised mitral and aortic valves were involved by a proliferative process that was strikingly similar to lesions described in patients with carcinoid heart disease and methysergide-associated valvular disease.