A migraine cocktail is a combination of medications that people can take to treat severe migraine. Doctors administer these medications in hospitals, although over-the-counter (OTC) migraine cocktails are also available.
A migraine cocktail may contain a combination of anti-inflammatories, drugs that alleviate nausea and vomiting, and medications that specifically target migraine.
In this article, we will look in more detail at migraine cocktails, their ingredients, potential side effects, OTC and homemade options, and other migraine treatments.
The term “migraine cocktail” is an informal way of describing the combination of medications doctors can administer to people in the hospital when they experience severe migraine.
If a person visits the emergency room (ER) with severe migraine symptoms, including intense pain, doctors will first rule out other conditions, such as a thunderclap headache. Then, they can provide several medications through an intravenous (IV) line.
According to Dr. Jessica Kiarashi, migraine cocktails typically reduce symptoms within 60 minutes. Doctors may add one medication at a time, but typically, they administer several at once, as
If the migraine cocktail does not appear to be working, doctors may try other medications, such as valproic acid, an epilepsy drug that also works for severe migraine pain in around 10–15 minutes.
Doctors can use a variety of drugs in migraine cocktails. The ones they choose may depend on a person’s symptoms and medical history.
A migraine cocktail from doctors in the ER
- Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications reduce inflammation, which contributes to pain and throbbing. Several NSAIDs are effective at treating acute migraine, but for a migraine cocktail, doctors may use ketorolac.
- Acetaminophen: This pain medication can be useful together with NSAIDs. However, doctors can only use it if a person has not already taken some before heading to the ER.
- IV fluids: People experiencing severe vomiting as a result of migraine can become dehydrated. Dehydration itself can also be a migraine trigger. In these cases, doctors may recommend IV fluids.
- Antiemetics: These drugs reduce symptoms such as nausea and vomiting. To reduce the risk of side effects, doctors may also include the antihistamine diphenhydramine (Benadryl).
- Dexamethasone: This medication is a type of steroid and reduces inflammation in the body. Research suggests dexamethasone may help prevent migraine from coming back after initial treatment.
While the findings of the review are not conclusive, the researchers suggest this could be a helpful component to emergency migraine treatment.
In severe cases where first-line treatments do not work, doctors may prescribe opioids.
Typically, people tolerate the medications in migraine cocktails well. However, some individuals may experience side effects.
The side effects of a migraine cocktail depend on the drugs it contains. The most common include:
|Drug type||Side effects|
|IV magnesium sulfate||electrolyte imbalance|
high magnesium levels
Frequent or high doses of any of these medications may cause more severe adverse reactions or toxicity. In rare cases, people can also experience allergic reactions.
A person should tell a doctor if a migraine cocktail causes severe or prolonged side effects.
OTC migraine cocktails are also available for the treatment of mild to moderate migraine. These products typically contain three active ingredients:
Aspirin and acetaminophen reduce pain and inflammation. Caffeine acts as a vasoconstrictor, a substance that narrows the blood vessels to reduce pain.
This combination is highly effective in treating migraine pain. However, it is worth noting that for some people, caffeine can be a migraine trigger. It can also cause anxiety, agitation, and trouble sleeping.
According to the American Migraine Foundation, taking OTC migraine medications too frequently can cause medication overuse headaches, and reduce how effective they are.
If a person takes OTC migraine cocktails more than 2–3 times per week, they should speak with a doctor or migraine specialist. People should also check it is OK to take these products if they are pregnant, breastfeeding, take other medications, or have any other underlying conditions.
It is possible to make a migraine cocktail at home using individual OTC pain medications combined with the caffeine from tea or coffee. However, it is best to consult a doctor or pharmacist before doing this.
To make an at-home migraine cocktail that resembles OTC products, people can take:
A migraine cocktail can be an effective treatment for occasional migraine. However, there are other treatment options that may be more suitable for people with frequent or severe migraine. These include:
A wide variety of factors can contribute to the development of migraine. Some people find that by identifying and eliminating migraine triggers, they can reduce the number of episodes they have.
Depending on a person’s triggers, this may include:
- getting enough sleep and having a regular sleep-wake schedule
- staying hydrated
- eating regular meals
- avoiding caffeine, alcohol, nicotine, or cigarette smoke
- avoiding specific trigger foods
Keeping a migraine diary can help with identifying migraine triggers over time.
A person who experiences chronic migraine may benefit from taking more specialized migraine medications, such as:
- triptans, which can stop the progression of individual migraine attacks
- ergotamines, which work in a similar way to triptans
- calcitonin gene-related peptide inhibitors, such as erenumab (Aimovig), which can prevent migraine
- Botox injections
These may be more effective than OTC analgesics, particularly for people with severe or frequent migraine.
Some other common medications that can reduce the frequency of migraine include:
- some antidepressants, such as amitriptyline
- some seizure medications
- some blood pressure medications, including beta-blockers
- hormonal medications, such as estrogen-free hormonal birth control, for those with menstrual migraine
If a person already requires one of these medications, they may help with treating or managing migraine too.
Relaxation and biofeedback
Several complementary therapies show promise for reducing the frequency of migraine. These include relaxation training and biofeedback, a technique that teaches people to become aware of bodily processes so they can control them.
A migraine cocktail is a combination of medications that reduce migraine symptoms, such as pain and vomiting. Doctors may administer a migraine cocktail to those who go to the hospital with severe migraine.
OTC versions of migraine cocktails are available. These can effectively treat migraine in people with moderate symptoms. Alternatively, people can take a combination of aspirin, acetaminophen, and caffeine at home.
Individuals who have severe or frequent migraine should contact their doctor about other treatment options available.