Migraine headaches are often treated with a combination of medications that is sometimes called a “migraine cocktail.” Depending on how severe migraine symptoms are, a migraine cocktail could be a treatment used in an emergency department or emergency room (ER), an infusion center, or even at home. Ingredients of a migraine cocktail will vary, depending on the situation.

“On my way to the ER, I need a migraine cocktail ASAP😭,” a MyMigraineTeam member wrote.

Sometimes, people are confused about the term “migraine cocktail” and may think it’s a beverage that treats migraine episodes. That isn’t the case. But like a cocktail drink, a migraine cocktail is a mixture of ingredients — that is, medications — that are combined to be more effective for migraine pain relief and treating migraine itself.

Understanding Migraine Cocktails

In some cases, you can treat migraine at home with over-the-counter medication or prescription drugs such as triptans, which work by constricting blood vessels in the brain. When symptoms persist or are debilitating despite home treatment, your doctor may recommend that you go to an ER, urgent care facility, or infusion center. Generally, symptoms that last more than three days may need urgent care.

“Ended up in the hospital last night. Couldn’t take my migraine much longer. They gave me a cocktail for migraine,” a MyMigraineTeam member shared. “I have had it for three days, throwing up, pounding headache.”

Another member wrote, “I was sent to urgent care for the migraine cocktail shot and anti-nausea meds.”

People who experience migraine auras — visual and sensory sensations — for the first time sometimes seek emergency care, especially if the symptom is alarming or is confused with a stroke. Migraine and strokes sometimes have similar symptoms such as visual symptoms, headache, slurred speech, dizziness, loss of feeling, or the sensation of pins and needles in the arms or legs. If you think you’re having a stroke, seek emergency care right away.

Severe migraine may need a combination of medications that are given with an injection or intravenous (IV, into a vein) infusion to deliver medication as effectively as possible. Medications can change in migraine cocktails because each migraine case is unique. Some drugs may be more effective than others, or someone may experience unpleasant side effects from a particular drug and it will be discontinued.

“My neurologist has finally found the magic migraine med cocktail that works!” wrote one member.

Keep a Record of Your Medications

Because migraine cocktails are not exact formulas, neurologists recommend that you keep track of each medication you take. If you’re given a migraine cocktail in an ER or infusion center by IV, the combination of medications may be noted in your online medical portal. If not, you can ask the doctor or nurses to provide a precise list of medications in your IV migraine cocktail and how much you were given of each drug. It’s important to keep a record of all medications used to treat your migraine headaches so that providers can better help you for future migraine attacks.

Here are some ingredients that are commonly used in migraine cocktails.

1. Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often taken orally to relieve migraine pain. When treatment is in combination with other drugs, a common NSAID used to treat acute migraine — attacks that come on suddenly and cause intense pain — is ketorolac. Ketorolac can be given by either intramuscular (in the muscle) injection or intravenously.

Potential side effects of ketorolac include internal bleeding; swelling of the face, hands, or legs; rash or sores; and high blood pressure, among other rare side effects.

2. Magnesium

Magnesium is a mineral that is found in many plant-based foods and is a nutrient that the body needs to function properly. Magnesium deficiency is believed to be a factor in migraine and is sometimes taken orally to help prevent migraines. IV magnesium may be given in a migraine cocktail for the treatment of acute migraine.

Side effects of magnesium are relatively uncommon and might include diarrhea, dizziness, muscle paralysis, and trouble breathing.

3. Diphenhydramine

Diphenhydramine (Benadryl) is sometimes used in combination with other drugs to treat acute migraine and can be given by mouth or as an injection or infusion. Diphenhydramine is an antihistamine that is sometimes used to treat allergies. Research from the Annals of Emergency Medicine has suggested that allergies may play a role in the development of migraine.

However, some research has shown that although a migraine cocktail with diphenhydramine may provide migraine relief initially, it may not be effective after 48 hours. Side effects include dry mouth and nose, dizziness, drowsiness, and nausea.

4. Dihydroergotamine

Like some other drugs used to treat migraine, dihydroergotamine is available in various forms and can be taken orally, nasally, by injection, or by IV infusion. It is believed to work by decreasing inflammation in nerves and blocking nerve pathways that are linked to severe migraine attacks. Dihydroergotamine is more commonly associated with side effects and is normally saved for more severe migraine headaches. Common reactions include dizziness, shortness of breath, anxiety, and nausea. Serious reactions include bleeding and heart complications. This medication is not to be used during pregnancy and is not recommended during breastfeeding.

5. Antiemetic Drugs

Antiemetic medications such as prochlorperazine or metoclopramide are used to counter nausea and vomiting that are often caused by migraine. Antiemetics are more effective when taken by injection or IV infusion because they are absorbed into the body better than if taken in pill form. Antiemetics are sometimes used in migraine cocktails with other medications.

Potential side effects include dizziness, headache, and constipation. Heart problems can occur in some people with a history of certain heart conditions. Additionally, individuals with mental health illnesses may find their symptoms worsening after taking certain types of antiemetics.

6. Dexamethasone

Dexamethasone is an oral or IV corticosteroid (steroid) used to prevent migraine headaches from recurring after emergency migraine treatment. As many as two-thirds of people with acute migraine experience head pain within two days of treatment of migraine. Dexamethasone may help reduce the frequency of migraine attacks and can help reduce the need for medication and doctor visits.

Side effects of dexamethasone can include allergic reactions, high blood pressure, confusion and mood changes, abdominal pain, and fever.

7. Intravenous Fluids

IV fluids are often given for hydration when people have acute migraine because dehydration can be a migraine trigger. IV fluids are also believed to help counter other migraine symptoms such as fatigue.

Although generally well tolerated, side effects of IV fluids might include fluid overload, infection, and hematoma (blood under the skin) or infiltration (the drug goes into tissues instead of veins).

8. Excedrin Migraine

Sometimes, you can treat a migraine at home with over-the-counter (OTC) medications. An OTC migraine cocktail that has a combination of medications within one pill of aspirin, acetaminophen, and caffeine is commonly used. Rather than trying to make a migraine cocktail yourself, you can find these ingredients in the OTC medication Excedrin Migraine.

“I take two Excedrin and then put an ice pack on the back of my head with an eye mask on. Usually, 20 minutes later, it’s gone,” a MyMigraineTeam member shared.

Aspirin is an NSAID, acetaminophen is an analgesic (pain reliever), and caffeine is a stimulant. Together, these ingredients can sometimes be effective in relieving a migraine when symptoms first start.

Be sure to talk to your doctor for medical advice about how best to use Excedrin with any other medication you have for treating the onset of a migraine headache. Taking too much pain medication risks medication overuse headaches, which can severely affect your quality of life. Other potential side effects include allergic reactions, anxiety or shakiness, insomnia, liver damage, and stomach bleeding.

Prescription Migraine Cocktails

Your doctor may recommend another home migraine cocktail with OTC meds, prescription medication, or a combination of both that may have some of the ingredients used in hospitals but can be taken orally.

A MyMigraineTeam member wrote, “Just woke up from a pounding migraine, ate breakfast — it seemed to help, but just in case, I took a cocktail this morning.”

Another member said, “I had to break out my at-home cocktail to try to stop the migraine in its tracks before it got debilitating. I am so thankful my neurologist understands migraines.”

Discuss Migraine Cocktails With Your Doctor

Your primary care doctor or neurologist can provide more information on when and where a migraine cocktail might be an appropriate treatment option for you, particularly if you have chronic migraine that affects you for more than half the month.

Talk to your doctor about the potential side effects of any new drug, and let them know if you have any allergies. Your doctor needs to know if you are pregnant or breastfeeding or if you’re experiencing any health changes they may not know about.

It’s essential to keep your doctor up to date on any changing or worsening migraine symptoms.

To help prevent migraine, maintain your treatment plan and avoid migraine triggers. If your current migraine medication isn’t effective or you’re experiencing unwanted side effects, talk to your doctor about your treatment goals and whether it’s time to switch treatments.

Find Your Team

MyMigraineTeam is the social network for people with migraine and their loved ones. On MyMigraineTeam, more than 82,000 members come together to ask questions, give advice, and share their stories with others who understand life with migraine.

Have you been treated with a migraine cocktail? Share your experience in the comments below, or start a conversation by posting on your Activities page.