What Is a Migraine Cocktail?
A migraine cocktail is a combination of medications that you may use at home to treat a migraine headache. This term is also used to describe combinations of medications that doctors may use to treat your migraine if you seek medical help for one of those intense headaches at a hospital.
Migraine cocktail stigma
Many doctors and people who experience migraines dislike the phrase “migraine cocktail.” According to a 2022 survey of 1,000 members of the American Migraine Foundation community, 9.87% said they found the term migraine cocktail “stigmatizing,” while 7.28% called it “demeaning.”
The reason seems to be that “cocktail” is a common term for an alcoholic beverage. Understandably, people who have migraines don’t want others to think that they drink alcohol to ease their headaches. However, “cocktail” can also be used to describe a combination of medications. It’s worth adding that nearly 40% of survey respondents said they had no problem with the term migraine cocktail.
What’s in a Migraine Cocktail?
A migraine cocktail contains medications that are intended to relieve headaches and other symptoms caused by migraines. There is no single recipe for a migraine cocktail. However, one commonly used combination of over-the-counter (OTC) medications for treating migraines contains:
- Acetaminophen (better known as Tylenol)
- Aspirin
- Caffeine
If you go to a hospital for treatment of an acute migraine, your doctor may use a different type of migraine cocktail, likely including prescription medications. If you are having a relatively mild migraine attack, doctors may try to ease your symptoms by giving you a combination of analgesics, such as NSAIDs or acetaminophen, plus a type of migraine drug called a triptan. If your migraine is more serious, your doctor may add additional medications. For a severe migraine that has lasted at least three days, doctors may try a cocktail that includes some or all of the following:
- IV fluids
- An NSAID called ketorolac (given by injection or infusion)
- A dopamine receptor blocker, such as prochlorperazine, metoclopramide, or chlorpromazine
- Valproate, which is usually used to treat convulsions
- Dihydroergotamine, a commonly used migraine drug
Doctors may also choose other combinations of migraine medications to treat your headache.
Migraine cocktail with Benadryl
If you go to a hospital for treatment of a severe headache, you may receive a migraine cocktail that contains diphenhydramine, which is the generic name for Benadryl. Doctors may add this medication because it can reduce certain side effects caused by other migraine medications. In particular, it may help prevent involuntary body movements, which can be caused by drugs called antiemetics. Some doctors think Benadryl may also help treat migraines, but that has not been proven.
Why Do People Get a Migraine Cocktail?
If you experience frequent migraine headaches, your doctor has probably prescribed medications to keep them under control and ease the pain and symptoms when one strikes. But sometimes, you may have a migraine so severe that it won’t respond to your usual pain-relieving medicine. If you have such a migraine that won’t let up, especially if it lasts three days or more, a migraine cocktail may offer relief.
Where to Go for a Migraine Cocktail
Your doctor may suggest a migraine cocktail that you can use at home. However, you may also receive a migraine cocktail if you go to a hospital for treatment of an unrelenting and severe headache. Often, that may mean going to an emergency room. However, your doctor may also give you a migraine cocktail at an outpatient infusion center or in a hospital room, if you've been admitted.
What to Know About Going to the ER for a Migraine Cocktail
Don’t hesitate to go to an emergency room if you have a persistent migraine that doesn’t respond to your usual treatment plan. However, beware that health care workers may sometimes be skeptical when people seek treatment for migraines in the emergency room, warns the American Migraine Foundation. Some may believe you are exaggerating your symptoms. Patients may even be suspected of “drug-seeking” behavior, that is, attempting to obtain medications for illicit purposes.
Arriving at the emergency room prepared can help you get the treatment you need and make the experience more tolerable. Here are some things to bring:
- A trusted friend or family member, who can vouch for your symptoms and help make sure you get the proper care.
- A letter confirming that you have been diagnosed with migraines from the doctor who you usually see for treatment. It should include a list of medications that have provided you relief in the past.
- A full list of medications you currently take. Bring the containers, if possible.
- A headache diary, if you keep one.
- Medication, water, and a snack, as you may be in for a long wait.
Over-the-Counter Migraine Cocktail
You can buy an OTC migraine cocktail at a drugstore, grocery store, or online. These products typically contain a combination of acetaminophen, aspirin, and caffeine. About 1 in 5 people who are having a migraine will experience complete relief of symptoms from this combination within two hours, according to a 2021 analysis. About half will experience at least a 50% reduction in symptoms within two hours.
OTC migraine cocktail ingredients
A typical OTC migraine cocktail contains these ingredients:
- 250 milligrams of acetaminophen
- 250 milligrams of aspirin
- 65 milligrams of caffeine (about two-thirds of what you would get from a cup of coffee)
Migraine Cocktail Side Effects
Most of the various ingredients used in different versions of the migraine cocktail are generally considered safe but may have side effects. Here are some common ingredients in migraine cocktails and their potential side effects:
Acetaminophen. Headache (if overused, known as medication-overuse headache), liver damage, and kidney damage, among others
Aspirin. Ulcers, stomach bleeding, kidney problems, and Reye syndrome (in kids under 12), among others
Caffeine. Jitteriness, nausea, stomach pain or discomfort, dizziness, sleep problems
Dihydroergotamine. Skin rash, swelling (in your face, lips, or tongue), irregular heartbeat, muscle discomfort, chest pain or tightness, tingling or numbness in your hands or feet, leg weakness, and vomiting
Dopamine blockers. Restlessness and inability to sit still, involuntary muscle movements, changes in heart rhythm, dizziness from low blood pressure, and sleepiness, among others
Ketorolac. Swelling in the face, fingers, and lower extremities are the most common side effects (may cause other symptoms such as high blood pressure, bruising, and skin changes)
Triptans. Dizziness, sleepiness, skin flushing, nausea, pain (especially in the neck), sweating, skin tingling or numbness, feeling weak
Valproate. Gastrointestinal problems (such as nausea, vomiting, and stool changes), changes in mood and thinking (such as depression and confusion), chills, headache, weight gain, sleep disturbances, and many others
Migraine Cocktail Alternatives
Taking steps to reduce your migraine attacks can help you avoid needing a migraine cocktail. The following can help lower the number of attacks you experience:
- If your doctor has prescribed preventive medication, take it as directed.
- Exercise regularly.
- Stick to a meal routine by eating at the same time every day.
- Stay well hydrated by drinking fluids, especially water, throughout the day.
- Get plenty of sleep and follow a routine for going to bed and waking up.
- Find a way to manage stress, which can trigger migraines, such as meditation or yoga.
- Keep a headache diary, which will allow you to spot migraine triggers and avoid them.
Takeaways
A migraine cocktail is a combination of medications that may help ease your migraine headaches when they are severe and long-lasting, and your usual treatment plan doesn’t provide relief. You can give yourself a migraine cocktail at home, though these multidrug treatments are often given in hospitals. If you get frequent migraines, talk to your doctor about treatments that can prevent and treat these headaches, which may include a migraine cocktail.
Migraine Cocktail FAQs
What are the ingredients in a migraine cocktail?
“Migraine cocktail” is an informal term for a combination of treatments designed to relieve a severe migraine headache. There are various versions of migraine cocktails, which may include over-the-counter or prescription drugs. The combination that works best may vary from one person to another.
Is a migraine cocktail safe?
The different medications used in migraine cocktails are generally considered safe, but any drug can cause side effects. Check with your doctor before taking any medication, including those in a migraine cocktail.
What will the ER do for a migraine?
If the doctor and health care team who treat you in an ER determine that you have a migraine, they may try various treatments to ease your symptoms. That may include a migraine cocktail or a combination of treatments, which may be given through an IV line in one of your veins.
How much caffeine is in a migraine cocktail?
When caffeine is part of a migraine cocktail, the recommended dose is 65 milligrams.
