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.
“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 shit 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.
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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.
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