What to Know About a Migraine Cocktail

Curated by Claudia Shannon / Research Scientist / ishonest

It’s estimated that 1 in 7 Americans experience migraine. While there’s no cure, migraine is often treated with medications that ease symptoms or help prevent migraine attacks from happening in the first place.

Sometimes, in medical settings, migraine symptoms may be treated with a “migraine cocktail.” This isn’t a drink, but rather a combination of specific medications to help relieve migraine symptoms.

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This article will take a closer look at what’s in a migraine cocktail, the possible side effects, and other migraine treatment options.

What is a migraine cocktail?

If you find yourself seeking medical attention for migraine pain, one of the treatment options you may be given is a migraine cocktail.

But what exactly is in this migraine treatment, and what do the different ingredients do?

It’s important to note that the medications in a migraine cocktail can vary depending on other medical conditions and your previous response to migraine rescue treatments.

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Some of the medications that may be included in a migraine cocktail include:

  • Triptans: These medications have anti-inflammatory effects and are thought to narrow the blood vessels in your brain, helping to ease pain. An example of a triptan in a migraine cocktail is sumatriptan (Imitrex).
  • Antiemetics: These medications can help with pain, too. Some may also relieve nausea and vomiting. Examples that may be used in a migraine cocktail include prochlorperazine (Compazine) and metoclopramide (Reglan).
  • Ergot alkaloids: Ergot alkaloids work in a similar way to triptans. An example of an ergot alkaloid used in a migraine cocktail is dihydroergotamine.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs are a type of pain-relieving medication. One type of NSAID that may be present in a migraine cocktail is ketorolac (Toradol).
  • IV steroids: IV steroids work to ease pain and inflammation. They may be given to help prevent your migraine from coming back in the next few days.
  • Intravenous (IV) fluids: IV fluids help replace any fluids you may have lost. These fluids also help prevent side effects from the medications included in the migraine cocktail.
  • IV magnesium: Magnesium is a natural element that’s often used to prevent migraine attacks.
  • IV valproic acid (Depakote): This is a seizure medication that can be used to treat a severe migraine attack.

The medications in a migraine cocktail are often given via IV. Generally speaking, it takes about an hour or longer for the effects of this treatment to start working and to feel symptom relief.

Are there side effects?

Each of the medications that may be included in a migraine cocktail has its own side effects. Some of the common side effects for each of the medications include the following:

  • fatigue
  • aches and pains
  • tightness in areas like the chest, neck, and jaw
  • muscle tics
  • muscle tremors
  • restlessness
  • sleepiness
  • stomach upset
  • nausea
  • vomiting
  • stomach upset
  • diarrhea
  • abdominal pain
  • nausea
  • dizziness
  • trouble sleeping

What about an OTC migraine cocktail?

You may have also heard about an over-the-counter (OTC) migraine cocktail. This is a combination of three drugs:

  • Aspirin, 250 milligrams (mg): This medication is used to reduce pain and inflammation.
  • Acetaminophen, 250 mg: It relieves pain by reducing the number of prostaglandins your body produces.
  • Caffeine, 65 mg: This causes vasoconstriction (narrowing of blood vessels).
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When taken together, each of these ingredients can be more effective at relieving migraine symptoms than the individual ingredient.

This effect was observed in a 2005 study. A fixed combination of aspirin, acetaminophen, and caffeine was found to provide significantly more relief than each medication by itself.

Excedrin Migraine and Excedrin Extra Strength are two OTC medications that contain aspirin, acetaminophen, and caffeine.

However, doctors often advise patients to avoid Excedrin and its derivatives due to the risk for medication overuse headache.

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Instead, doctors recommend taking ibuprofen (Advil, Motrin), naproxen (Aleve), or acetaminophen (Tylenol). They generally advise against OTC caffeine, as it can cause unpleasant side effects like a racing heart and insomnia.

There are also generic brands that may have the same combination of ingredients. Be sure to check the product packaging to confirm the active ingredients.

How safe is an OTC migraine cocktail?

OTC migraine medications that contain aspirin, acetaminophen, and caffeine may not be safe for everyone. This is especially the case for:

  • people who’ve had a prior allergic reaction to any of the three components
  • anyone taking other medications that contain acetaminophen
  • children under 12, due to the risk of Reye syndrome
  • the risk for medication overuse headache

Talk to your doctor before using this type of product if you:

  • have a very severe migraine attack or a head pain that’s different from your typical episode
  • are pregnant or breastfeeding
  • have liver disease, heart disease, or kidney disease
  • have a history of conditions like heartburn or ulcers
  • have asthma
  • are taking any other medications, specifically diuretics, blood-thinning drugs, steroids, or other NSAIDs
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Some potential side effects of this type of medication include:

  • abdominal pain
  • nausea or vomiting
  • diarrhea
  • dizziness
  • trouble sleeping
  • medication overuse headache

What other types of medication may help?

There are other medications that may help relieve migraine symptoms. These are typically taken as soon as you feel the onset of symptoms. You may be familiar with some of them from the sections above. They include:

  • OTC medications: These include drugs like acetaminophen (Tylenol) and NSAIDs like ibuprofen (Advil, Motrin), and aspirin (Bayer).
  • Triptans: There are several triptans that may help ease migraine symptoms. Examples include sumatriptan (Imitrex), rizatriptan (Maxalt), and almotriptan (Axert).
  • Ergot alkaloids: These may be used in situations when triptans don’t work to ease symptoms. Some examples include dihydroergotamine (Migranal) and ergotamine tartrate (Ergomar).
  • Gepants: These medications are often used to treat acute migraine pain and may be prescribed for patients unable to take triptans. Examples include ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT).
  • Ditans: These medications may also be used in place of triptans. An example is lasmiditan (Reyvow).

There are also medications that can be taken to help prevent a migraine attack from occurring. Some options include:

  • 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 medications like valproate and topiramate (Topamax).
  • CGRP inhibitors: CGRP medications are given via injection every month. Examples include erenumab (Aimovig) and fremanezumab (Ajovy).
  • Botox injections: A Botox injection given every 3 months may help prevent migraine in some individuals.

What about vitamins, supplements, and other remedies?

In addition to many types of medications, there are also non-pharmaceutical treatments that may help relieve symptoms or prevent migraine onset.

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Some options include:

  • Relaxation techniques: Relaxation practices like biofeedback, breathing exercises, and meditation may help reduce stress and tension, which can often trigger a migraine attack.
  • Regular exercise: When you exercise, you release endorphins, which are natural pain relievers. Regular exercise may also help lower your stress levels which, in turn, may prevent migraine onset.
  • Vitamins and minerals: There’s some evidence that various vitamins and minerals may be linked to migraine. Examples include vitamin B-2, coenzyme Q10, and magnesium.
  • Acupuncture: This is a technique in which thin needles are inserted into specific pressure points on your body. It’s thought that acupuncture may help restore the flow of energy throughout your body. This may help ease migraine pain and limit the frequency of migraine attacks, although the research on this is inconclusive.

It’s important to note that some herbs, vitamins, and mineral supplements may not be safe for everyone. Be sure to talk to your doctor before trying these remedies.

The bottom line

A migraine cocktail is a combination of medications that’s given to treat severe migraine symptoms. The exact medications used in a migraine cocktail can vary, but it typically includes triptans, NSAIDs, and antiemetics.

A migraine cocktail is also available in OTC medication. OTC products usually contain aspirin, acetaminophen, and caffeine. These components are more effective when they’re used together than when they’re taken alone.

Many different types of medications are routinely used to treat or prevent migraine symptoms. Additionally, some herbs, supplements, and relaxation techniques may help, too. It’s important to talk with your doctor about the type of treatment that may work best for you.

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