A migraine cocktail refers to a combination of medications that can provide relief from a migraine attack. It’s estimated that 1 in 7 adults in the United States experience migraines. While there is no cure for migraines, they are often managed with medications that alleviate symptoms or prevent attacks from occurring.
In medical settings, migraine symptoms are sometimes treated with a “migraine cocktail.” This term does not refer to a beverage, but rather to a specific combination of medications aimed at relieving migraine symptoms.
This article will explore the components of a migraine cocktail, potential side effects, and other treatment options for migraines.
What is a Migraine Cocktail?
If you seek medical attention for migraine pain, you might be offered a treatment known as a migraine cocktail.
The specific medications included in a migraine cocktail can vary based on your medical history and how you’ve responded to past migraine treatments.
Some common medications that might be included in a migraine cocktail are:
- Triptans: These medications have anti-inflammatory effects and are thought to narrow blood vessels in the brain, helping to alleviate pain. An example of a triptan used in a migraine cocktail is sumatriptan (Imitrex).
- Antiemetics: These medications can help with pain and may also relieve nausea and vomiting. Examples include prochlorperazine (Compazine) and metoclopramide (Reglan).
- Ergot Alkaloids: These work similarly to triptans. An example is dihydroergotamine.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These are pain-relieving medications. Ketorolac (Toradol) is one type that might be used in a migraine cocktail.
- IV Steroids: These alleviate pain and inflammation and may help prevent the recurrence of migraines in the following days.
- Intravenous (IV) Fluids: These help replace any fluids you may have lost and prevent side effects from the medications in the migraine cocktail.
- IV Magnesium: Magnesium is a natural element often used to prevent migraine attacks.
- IV Valproic Acid (Depakote): This seizure medication can be used to treat severe migraine attacks.
Who Administers a Migraine Cocktail?
This type of treatment is typically administered in an emergency room or urgent care facility. It is used when your usual at-home treatments aren’t effective, or to treat a migraine attack lasting three or more days.
The medications in a migraine cocktail are often delivered via IV. Generally, it takes about an hour or longer for this treatment to start working and provide symptom relief.
Are There Side Effects?
Each medication that might be included in a migraine cocktail comes with its own set of side effects. Here are some common side effects associated with each type of medication:
- Triptans:
- Fatigue
- Aches and pains
- Tightness in areas like the chest, neck, and jaw
- Neuroleptics and Antiemetics:
- Muscle tics
- Muscle tremors
- Restlessness
- Ergot Alkaloids:
- Sleepiness
- Stomach upset
- Nausea
- Vomiting
- NSAIDs:
- Stomach upset
- Diarrhea
- Abdominal pain
- Steroids:
- Nausea
- Dizziness
- Trouble sleeping
What About an OTC Migraine Cocktail?
You may have also heard about an over-the-counter (OTC) migraine cocktail. This typically consists of a combination of three drugs:
- Aspirin, 250 milligrams (mg): Used to reduce pain and inflammation.
- Acetaminophen, 250 mg: Relieves pain by reducing the number of prostaglandins your body produces.
- Caffeine, 65 mg: Causes vasoconstriction (narrowing of blood vessels).
When taken together, these ingredients can be more effective at relieving migraine symptoms than when taken individually. This synergistic effect was observed in a 2005 study, which found that a fixed combination of aspirin, acetaminophen, and caffeine provided significantly more relief than each medication alone.
Two OTC medications that contain this combination are Excedrin Migraine and Excedrin Extra Strength. However, doctors often caution against using Excedrin and similar products due to the risk of medication overuse headache.
Instead, doctors typically recommend taking ibuprofen (Advil, Motrin), naproxen (Aleve), or acetaminophen (Tylenol). They generally advise against OTC caffeine, as it can cause side effects such as a racing heart and insomnia.
Additionally, generic brands may offer the same combination of ingredients. Be sure to check the product packaging to confirm the active ingredients.
What Other Types of Medications May Help?
Several other medications may help relieve migraine symptoms, especially when taken at the onset of symptoms. Some of these you may already be familiar with from the sections above:
- OTC Medications: These include drugs like acetaminophen (Tylenol), NSAIDs such as ibuprofen (Advil, Motrin), and aspirin (Bayer).
- Triptans: Several triptans may help alleviate migraine symptoms. Examples include sumatriptan (Imitrex), rizatriptan (Maxalt), and almotriptan (Axert).
- Ergot Alkaloids: These can be used when triptans are ineffective. Examples include dihydroergotamine (Migranal) and ergotamine tartrate (Ergomar).
- Gepants: Often used for acute migraine pain, these may be prescribed for individuals who can’t take triptans. Examples include ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT).
- Ditans: These medications can also be used as an alternative to triptans. An example is lasmiditan (Reyvow).
Preventive Medications
There are also medications that can help prevent a migraine attack from occurring:
- Blood Pressure Medications: Examples include beta-blockers and calcium channel blockers.
- Antidepressant Medications: Amitriptyline and venlafaxine are two tricyclic antidepressants that may help prevent migraine attacks.
- Antiseizure Medications: These include drugs like valproate and topiramate (Topamax).
- CGRP Inhibitors: Given via injection every month, examples include erenumab (Aimovig) and fremanezumab (Ajovy).
- Botox Injections: A Botox injection administered every three months may help prevent migraines in some individuals.