What’s in a Migraine Cocktail?
A migraine cocktail isn’t a drink. Although, if you know of a drink that will take away a migraine please share it in the comments. A migraine cocktail is a mixture of medications that when taken together can greatly reduce or eliminate a migraine.
If you’ve been to the ER with a migraine they may have given you a migraine cocktail. But, just what is a migraine cocktail? What’s in it? I did a little research and this is what I found.
“I had a severe migraine was taken to the hospital….Dr there told me if you feel another one come to ER tell them you need a migraine cocktail. Have you ever heard this ? And what is it ?”
I received the above question from a reader and even though I’ve been in the ER with migraines before, migraine cocktail wasn’t a term I’d heard used there or elsewhere, so I had to do a little research.
Migraine Cocktails in the ER
I’ve been in the ER a couple of times with migraines and I can tell you that what they’ve given me is, at best, a combination of nausea meds with either a triptan or something like hydrocodone. Every time they’ve also sent me home with a script for Hydrocodone (or similar narcotic pain med).
I’ve found this amusing each time because quite simply (in my experience) narcotics don’t do anything for a migraine. It seems that most ER docs don’t have a clue about migraines or how to best treat them, then again a lot of neurologists don’t even grasp the concept.
In my short research I cam across this study about the “Treatment of Primary Headache in the ER“. This research was based on having patients (who had been to the ER for an “acute primary headache” fill out a post-care survey).
Acute primary headache basically means it’s not chronic AND that it’s not caused by some other reason. Of the patients that filled out the survey, 95% of them met the diagnostic criteria for migraine. However, only 32% were diagnosed as migraines in the ER.
7% received a triptan (or some other migraine “specific” drug)
65% were given a “migraine cocktail” (a mixture of an NSAID, a dopamine antagonist, and/or an antihistamine)
24% were treated with opioids.
Based on this, it sounds like there isn’t a specific “migraine cocktail” but more that it’s whatever combination your particular ER mixes up and gives you. Regardless of which medication is given, none of the patients that were surveyed were able to return to normal function, and 65% reported that they still had a migraine 24 hours later.
Migraine Cocktails at Home
There are a couple of combinations that have worked well for me at home.
Growing up my mom’s answer for a migraine (it worked for her, and it usually worked well for me up until I could no longer take OTC meds) was Excedrin and a Coke. Taking Excedrin with a Coke always seemed to work better than Excedrin alone.
Unfortunately, in my early 30’s after chronic migraine led to too much NSAID use, which lead to ulcers, I could no longer use that combination. I also really couldn’t take any over-the-counter migraine meds anymore without stomach upset.
My prescription migraine cocktail is:
Relpax and Promethezine – This combo seems to work pretty well. The nausea med both reduces any potential nausea from the migraine but also will usually help me fall asleep.
This combo was prescribed by my neurologist and I find it works best when both are taken together at the first sign of a migraine.
Do you have a migraine cocktail that you regularly take when a migraine hits? If so,what's in it? Share on X
Do you have a migraine cocktail that you regularly take when a migraine hits? If so,what’s in it? Share your thoughts in the comments below.
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Brenda G**** says
I cannot tolerate sumatriptan at all (vomiting so aggressive that I couldn’t tell you if my actual migraine was relieved to any degree).
I used to tolerate rizatriptan better, but I can now I only tolerate a single dose and even then I have terrible tightness in my chest and throat. This is a big change from when I first took it 20ish years ago, when I often said that my only side effect was sneezing a few times 15-20 minutes after dosing.
Unless I leave it too late, I use a cocktail of naproxen, acetaminophen, caffeine, meclizine, and diphenhydramine. If the pain phase (I have unmistakable aura) starts before I can take my cocktail, I lead with rizatriptan.
Back in the day, I did well on Midrin. Does anyone remember that one? I still knew that I had a migraine, but it was like the pain was wrapped up in cotton wool and barely touched me. Sadly, it didn’t leave me remotely functional (definitely could not work or drive on the stuff). I’d love to have it for when I am safely at home and could rest and let it do its thing, though.
Sara Brightwell says
YES. MIDRIN is the only migraine medication that actually worked for me
J.C says
Imitrex didn’t work for me.
I use Fioricet. It has a barbiturate, caffeine and tylenol. Sometimes I’ll use Advil with it but I have an enlarged kidney that easily gets inflamed with NSAIDs so I must be careful with that.
I also use ice on the occipital joint on the right side and at times right eye when it seems it’ll explode.
Tens doesn’t work for me but Chiropractic weekly and massage helps reduce the frequency.
Madyson says
I have been on 100 mg of topomax for about a year now. My neurologist has also added fioricet to take as needed. I have gotten botox in the past and it made my migraines 100x worse. I just started my Amovig tonight. I also started a new cocktail of promethazine, chloropromazine, and diphenhydramine! I’m hoping it helps me out.
Sarah says
How do you like Amovig? I’ve been on it for 2 months now. I also use Motrin, flexiral and Benadryl when it’s super bad.
Tara Kirby says
I have Lupus, Fibromyalgia, and Lyme Disease and suffer from chronic migraines. I used to take Axert, and it worked great for me until my insurance stopped covering it. They switched me to naratriptan which just isn’t nearly effective enough. Recently, I have been trying advil migraine. I always use lavender essential oil on my temples, above my eyebrows, and at the base of my skull. I also use ice packs on my forehead and back of my neck at base of my skull. My doctor recently suggested a new med Emgality as a preventative. It is a monthly injection pen. There’s a coupon so it’s free for the first year. I started it in January, and some months it cuts my migraines in half or better, and some months it doesn’t seem to work as well.
Does any one else seem to get them at the same time every day and feel like they are connected to sinuses or allergies? I take an allergy pill every day and use a nasal spray as well but still have issues. I really hate it that any of us has to deal with these awful migraines.
Julie says
Getting them at the same time every day sounds a lot like cluster headaches or cluster migraines.
I loved Advil until I couldn’t take it anymore. Be careful taking it too often or using it as a primary med if you are getting migraines daily. That’s what happened with me and it ended up giving me an ulcer so that I can’t use any nsaids at all anymore. It’s a bummer because Advil and a Coke was my “migraine cocktail” for the first half of my life or so.
Kaitlyn Layton says
This is by far one of my favorite articles online about a migraine. Everytime I go to the ER the doctors and nurses have no idea what a migraine is and I’ve had them before not believe in them. Excedrin Migraine usually does the trick but not so much after all the years of taking it. My ER gives me Benadryl, Compazine and something else. They used to give me Reglan until I wanted to crawl out of my own skin two times where I needed the IV taken out. Thank you for writing this article!!
Julie says
Thanks Kaitlyn, I’m glad you found it helpful. I know what you mean about Reglan… it can often come with some funky side effects.
Maria Adela says
I hate reglan. I get severe akathisia. The migraine combo in my general area (this includes Philadelphia and the NJ suburbs near it) is benadryl (used to be Cogentin to combat the chlorpromazine(aka Thorazine) /haldol’s effects (akathisia etc.)I also tend to get extra nausea relief meds (ondansetron/Zofran 4mg IV push) due to my already constant nausea due to gastroparesis being exacerbated.
All opiates/opioids are NOT to be given in cases of migraine due to high probability of bounce back migraines.
I tend to be OK with my triptans and push zofran via my J-tube for the nausea. I use the subQ pen for when I’m too nauseous or already throwing up as I would hate to puke one of the very few pills that come in a given refill.
Maria Adela says
Note: cannot take NSAIDs due to 7+upper GI bleeds in my past medical history and current erosive gastritis and an ulcer.
Lynn says
Lately my go to at home cocktail is 2 Excedrin migraine and 2 Dramamine. Wash it all down with a Coke or Orange Fanta. Seems to be working so far. I have hormone induced migraines that I can’t track a pattern for the life of me.
Julie says
Oh I miss being able to take Excedrin. That was always our “cocktail” growing up. It’s what my mom used – 2 Excedrins and a Coke – and what I always used as well, until the migraines became so chronic that I was alternating between Excedrin and Treximet -a prescription migraine med that combined an NSAID with a triptan. I couldn’t take either of them as often as I needed at the time, but between them I ended up with an ulcer from so much NSAIDs and now I can’t take any of them.
Cathy Williams says
I get the fibro type migraines (that I don’t actually believe are migraines but) I find that the best thing is ice. Always ice. Pain killers are useless. Tryptans don’t work for me BUT that’s because mine are often not migraines per se. However, tryptans DO work well for many. Caffeine can help some by constricting the blood vessels. This is often also in migraine medication.
I still find the fastest way to get over a migraine is to avoid chaotic places like A&E (unless you have cause for concern) and to go to bed in a dark, quiet room with lots of ice on your forehead and back of your neck.
Please note that even though I have a medical background I am NOT a medical doctor (I’m a Dr of Physiology) and this advice is based on MY experiences. Cath x
Christie says
I agree 100% with the ice.. especially at the base of the neck. That will help the most while the ice on the temple is mainly for comfort- also needed!
As for my cocktail, I take topamax daily as a preventative. That’s helped significantly. When a migraine attacks, I’m to take one 100mg Imitrex, one Excedrin migraine, four ibuprofen, and one promethazine if nausea is present. I coat myself is a brand-specific roller blend of essential oils and curl up with my ice packs and a bucket. If the migraine isn’t improved in an hour, I’m instructed to repeat all but promethazine.
It’s rough. I’ve got a history of bleeding ulcers so I have to take good care of myself between attacks to allow for all the meds. I often feel like junk for a good day even after the migraine is gone but at least it’s gone!
Jenn says
Hi. I’ve heard that an intravenous treatment of magnesium really helps. You need to ask a Naturopath about this.
Hope says
I had a migraine cocktail the other day, no one told me what was in it, i told them what i was allergic to and they come back with 3 other of IV fluids for me. I went back in to the ER 3 hours after being released with a anxiety attack. whatever they gave me triggered my anxiety. and I wouldnt recommend the migraine cocktail to anyone. it was terrible.
Julie says
That’s terrible. Perhaps you should go back and ask for a copy of your records from that visit to find out what they gave you.
Jennifer says
OTC headache cocktail: 600 mg of Motrin, 1000 mg of Tylenol, 130 mg of caffeine and 50 mg of Benadryl. You can also increase up to 800 mg of ibuprofen and up to 1500 of acetaminophen. This will knock it out immediately. Cold compresses on temples and neck will help too.
Julie says
I miss being able to take motrin. Back when I could handle ibuprofen my goto mix was 2advil and a coke (if that didn’t work then I’d add in an excedrin). Too many of those and ulcers later and I can’t take ibuprofen or aspirin, and mixing in caffeine is like lighting my stomach on fire.
Jen wolf says
Could we talk? My story is similar to yours I have found something that works for me I also can’t take ibuprofen and have had ulcers.
Julie says
Hi Jen,
Feel free to share here, or if you want to interact more privately you can email me at julie@countingmyspoons.com
Carry says
I have had migraines my whole life there’s been probably a hundred times I have had to go to the ER to get a migraine cocktail which is a mixture of Toradol Benadryl and Zofran this cocktail works very well not only does it get rid of the pain it is also not narcotic and the Benadryl helps you sleep.
Jmike says
I went to the er the other night…2 days ago…and I have the migraine cocktail and I haven’t felt right since I’m all anxious and stuff and it’s scary to fall asleep. I’m like scared or something
Julie says
Might be a reaction to one of the drugs in the cocktail. I would call the doctor or go back to the ER.
caroline says
it happened to me too and ended up in a suicidal crisis. The cocktail has many unnnecessary medications, its meant to dope you not to heal you. The reality is that the ingredient composite and reglan triggers psychotic reactions which damages their plan. It is supposed to stop nausea (which I didnt need , cause I told them I didnt have nausea, just the typical killing pain and hemiplegia). So do yourself a favor if you have a migraine, if you are beyond you limits of pain and weird symptoms go to ER but having in mind that ER is only good to discard a stroke by having them do a catscan . BUT then go back home to retreat your self cause the ER doctors have no clue how to stop a migraine or help you, and just want to experiment with you and if you react to their daily invention, they bully you. I ran away from ER that day, I knew deep inside I was going to be drugged even more after that and then hospitalized for weeks and started on psychiatrical medications. They had to accept months later that I, like many patients, have an allergic reaction to composite and reglan, and that is nothing wrong with the patient. It was wrong on the doctor to prescribe it on the fist place. I handled that reaction to that cocktail with thehelp of my family while detoxing my body intensively from all those pharmaceuticals , some xanax helped and magnesium and 3 days rest. Recently I am learning that lows of estrogen and testosterone triggers some of my migraines, some others are caused by a concussion i had some years ago, which is different. So, doctors are not gods, try functional doctors, they go deep into the root of your problems not just try to cover your symptoms.
Julie says
Sadly so true.
Mark Anderson says
I had a nightmare experience similar to what you describe. About a year and a half ago now, I had just had a tooth extracted that was causing a severe headache. I made the mistake of going to the ER. When I first got to the ER, I was offered percocet. I do NOT like taking drugs if I don’t have to, and I actually declined the percocet. Only to get into the back and be told they had a “headache cocktail” for me. I asked what that was. Decadron, Reglan, and Benadryl was the reply. Initially, I asked what they were and declined. Decadron is a steroid – like one of the most potent steroids. I have a strict policy against taking steroids, which doctors are all too quick to prescribe. And then Reglan is to offset the effects of Decadron or something like that. And Benadrol to offset the Reglan. I was like no, I don’t want to take all that stuff. Somehow, I ended up caving in. But I said no Benadryl. So they give me the Decadron and Reglan. Immediately, I react horribly to the stuff. Doctor tells me the Benadryl will help offset some of the symptoms. So I agree to the Benadryl. Well, after that, my heart was racing. I felt so uneasy. What really got me is while the doctor even admitted those drugs can cause side effects like that, the nurse who administered them implied I was having one big “anxiety attack” for describing how the drugs were negatively impacting me. I made it home a few hours later, and let me tell you my entire week that week was messed up. And another thing. The ER knew my headache was from an extracted tooth that had been infected. What do you think the steroid Decadron did? It slowed down my body’s ability to heal. I mean I had scrapes on my skin that stayed the same for an entire week. Normally, a scrape starts to heal and one week later would be gone. Mine stayed for an entire week plus. So I had that infection floating around in my head that wasn’t healing right either. How dumb to administer a steroid like that to somebody who is having a headache secondary to a tooth extraction? In fact, my dentist even noticed I only had about one week of healing on my extraction site after over two weeks during my follow up visit. Let me tell you that some of these prescription drugs are far more dangerous than street drugs, and I don’t say that to defend street drugs, as I don’t use any drugs. I’m just pointing out that legal medicine is very dangerous. I look at how the government is making a huge deal over the “opioid epidemic”. I have had narcotics before, I NEVER reacted to narcotics like I did that cocktail. It was so bad, I literally feel like I’m blessed to be alive. I mean it caused my heart to race. Looking back, I wish I had just taken the percocet. And what gets me is there was nobody there to record the adverse reactions. On paper, it’s as that never happened to me.
Julie says
The sad part is that most of the time when we hit the ER we are in such bad shape that we don’t even think to ask what they are doing/ giving to us, we are just happy to take whatever it is and go with it. I’m sorry you had to go through this.
ERNurse says
It takes over 30 days of being on a steroid to have a negative impact on your immune system. One dose in the er was not likely the cause of your issue.
Brian Ruesch says
The only prescription I found workes on my Migraines is Maxalt MLT, but check with your Dr. My wife can’t take anything more than Tylenol because of a interaction with her Fibromyalgia meds can cause a Stroke (she has already had one).
Julie says
I never had any luck with Maxalt. The only one I’ve had any success with really is Relpax, but it’s so limited on how many I can get in a month (insurance).
Michelle Emery says
Triptons cause the anxiety, mental mood changes. Neurologist will try it as a daily. Ppl react differently. I got a “tic” from my experience. I also can’t take Tylenol anymore. That causes ulcers and liver misfunction. Topamax is a suggestion but can’t use for long term. I love Botox!!
Melissa says
Sorry, I left out that I tried the Cerena TMS unit in my neurologist’s office and was pleasantly surprised that it worked. As for the other FDA-approved, non-medication treatment (Cefaly), my doctor said some people have great results with it. Because it’s $300, he said to first use the TENS unit I have to see if I respond to it.
Julie says
Interesting on the TENS unit, where did you put the leads? I can’t take TENS above my shoulders (and can barely take it there).
Nancy says
I like the cefaly quite a bit. Sometimes it feels stronger than triptans, sometimes I need them both.
April says
You said Topamax can’t be used long term… Are you referring specifically to yourself or you’ve been told this is how it should be for everyone? I am because I have been taking it for about 10 years probably, 50 twice a day. And after getting used to it, I haven’t had any real issues. It doesn’t work as well as it did at first better than
without it.
Melissa says
My neurologist wanted me to check into the hospital the day of my appointment to receive the cocktail. It also includes an anti nausea medication to combat that side effect of the cocktail. I’ve had migraines since I was 10. They used to be hormone based but, are now almost exclusively triggered by changes in barometric pressure. I’m diagnosed with chronic intractable migraines and am on low dose blood pressure medication as a preventative treatment and receive Botox every 3 months. I turned down the cocktail because, if you have a reactio, it takes hours to reverse.
Julie says
Thanks for the feedback Melissa. Are you on Verapemil?? I just started it last week for the cluster headaches / chronic migraines. So far I’ve not seen any improvement with it.
melissa says
Yes, I take 120mg of Verapamil 2x per day. The neurologist wanted me to take it 3x per day but, it made me very sleepy. The preferred blood pressure class is the beta blocker but, I’m hypoglycemic and couldn’t tolerate it. So, the doctor switched me to Verapamil. As for the TENS leads, one goes right over the eyebrow or where ever your primary generating point is (sometimes mine generate from the base of my skull), the other can go on your shoulder blade. It does work well and Cefaly is the same concept except the points of contact with Cefaly are much smaller. My neurologist has been the lead researcher for testing new medication and products in the treatment and prevention of migraines. He and I discussed the migraine ‘pace maker’ too. He said 50% of patients experience significant improvement (reduced frequency and severity of migraines). But, several problems exist. The first is that the leads too often move, which requires an additional surgery to move them back. The second is the risk of infection from the surgery. The third is that it’s still not FDA approved. So, in order to be included in a study, a patient would have to discontinue all migraine-preventative and migraine-aborting drugs. Finally, and this would pertain to you as well as me…he is hesitant to do any surgery on a Fibromyalgia patient. He rightly believes that the physical stress of the surgery could trigger or worsen a flare-up. He said given the track record of the pace maker, he wouldn’t suggest that I try it.
So, that leaves me with my Verapamil and my Botox as well as my TENS unit. The Botox is very painful, especially if you’re in the midst of a migraine. It involves 31 injections of up to 200 units, every 3 months. My doctor says it’s especially painful for me because I have chronic migraines and he’s injecting the solution into some of my generating points (that’s me paraphrasing) and because the Fibromyalgia means my pain threshold is a joke. Frankly, a ‘normal’ person wouldn’t be thrilled with being injected in their scalp, shoulder blades, back of neck. I try to relax and meditate before he begins but, it HURTS. That said, if the Botox didn’t work, I wouldn’t consent to the injections.
One of the other cruddy part of the migraines…when they’re intense and unending, my TMJ flares as well. I try to be conscious of not gritting my teeth from pain but, it happens when the pain from the migraine (the Fibro and/or my nerve damage) is bad enough. Irony: my migraines are on the right side of my head/face while my TMJ is primarily in the left jaw hinge thingee. So, there’s no way to sleep comfortably when the TMJ and migraines are happening together. I have to laugh about it or I’d cry – and crying makes the migraines worse. : )
Julie says
I totally understand about the TMJ, when I get tense (as migraines tend to make me) I will often find myself gritting my teeth. I try to be conscious of it to avoid it. It’s a really good thing I have a splint I wear at bedtime, it helps a lot.
It sounds like you have a great doc. You are lucky that he’s so well versed in all the migraine stuff AND that he seems to be aware of Fibro and what it means. I’ve had two surgeries since Fibro, one left me in a hella flare, the other nothing at all. I think the difference in the drs really being aware of what they were doing (and much more experienced) made a huge difference.
I just started on 180 Verepamil right before this cluster started a couple of weeks ago. So far, nothing for me. I need to call the neuro again on Monday and see what we can do.
Karen Sheridan says
I hate to butt in but i take drug called ZOMIG. but i live in Australia so it might have a different name elsewhere.However it works really well but you have to take it immediately you feel symtoms and it will take a couple of hours to work. But no side affects!! Good luck
Julie says
Hi Karen, you’re certainly not butting in. Zomig is an abortive medication that is pretty common for treating migraines. Unfortunately, sometimes it’s just not enough, which is why many land in the ER with migraines. Many often aren’t provided those medications until after they’ve made a few trips to the ER and are finally referred to a neurologist. Unfortunately, insurance companies can also be tricky with abortive medications failing to approve enough for those who experience chronic migraines. I’ve found myself in both situations. The couple of times I went to the ER were prior to receiving prescriptions for abortive medications. And even after receiving those prescriptions I’ve had situations where the # my insurance approved wasn’t even remotely close to enough to treat all the migraines I had in a month when I was experiencing chronic migraines.
Michell says
Thank you for sharing. I feel for you. Seems like lots of migraines on the right side, as myself. Thank you for sharing
Relief does not come from narcotis, orally, like hydrocodone, or any meds except a triptan. For me I have to take it (and it helps more with naproxen, there is a migraine triptan with naproxen. Don’t pay for it.
I have severe light photosensitivity and noise drives me crazy. Sleep and life cannot happen. I must have a triptan.
Best wishes to all of you! sumatropin is what I rake that helps especially with naproxen / alleve generic.
Unfortunately, I am on meds that don’t combine 100% with sumatropin. So I do the best I can anyway to keep it on hand, quicker the better.
For those who take migraine excederin, take naproxin. I’ve been told quickly down caffeine, but that in itself won’t cure it. It helps. I have autoimmune encephalopathy or encephalitis with a shrunken brain and frontal and parietal lobes moderate to severe shrinkinage. Lots of inflammation in the brain, therefore the body, nerve, and muscle/joint pain.
Someday… keep hoping for correct diagnosis and appropriate treatments.
Julie says
I took the triptan with naproxen for a while and it helped better than any med I ever took. Unfortunately, it also left me with stomach ulcers and an inability to take any NSAIDs for the rest of time.
I hope they find the correct diagnosis and help for you soon, for all of us.
Vicky Smirnoff says
One word – SUMATRIPTAN – it works every single time, even on the very worst migraines I get. It used to only be available as Imitrex, but now it’s generic. Ask for it! It is THE BEST!
Julie says
Sadly it’s never worked for me. 🙁
Heather says
I have never heard of a migraine cocktail lol. I used to use prescription medications for migraines but now I just use excedrin migraine which I seem to take everyday. I don’t think hydrocodone would help my migraines plus when I was put on that when I got my wisdom teeth out, I couldn’t keep anything down and then was just throwing up stomach acid and it is very rare that I throw up.
Julie says
Be careful taking so much Excedrin. I did the same thing early on with the chronic migraines and burned a whole in my stomach with the Nsaids, now all I CAN take are prescription meds. Those were the worst months of my life (and that was before Fibro).