From the Guidelines
A migraine cocktail should include a combination of a triptan, an NSAID, and an antiemetic, with the specific choice of medications based on individual patient preferences and needs, as recommended by the American College of Physicians in 2025 1. When treating acute episodic migraine headache, it is essential to consider the severity of the migraine and the patient's medical history.
- For mild episodic migraine headache, consider treating with an NSAID, acetaminophen, or the combination of an NSAID and acetaminophen 1.
- For moderate to severe acute episodic migraine headache, consider using a triptan, such as sumatriptan, in combination with an NSAID or acetaminophen, and add an antiemetic if the patient is experiencing severe nausea or vomiting 1.
- The choice of a specific NSAID (aspirin, celecoxib, diclofenac, ibuprofen, or naproxen) or triptan (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, or zolmitriptan) should be based on individualized decision making, taking into consideration patient preferences on such factors as route of administration and cost 1. It is crucial to counsel patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy to improve efficacy, and to be aware of the potential adverse effects of pharmacologic treatments during pregnancy and lactation 1.
- Additionally, consider using CGRP antagonists-gepants (rimegepant, ubrogepant, or zavegepant) or ergot alkaloid (dihydroergotamine) for moderate to severe acute episodic migraine headache in nonpregnant outpatient adults who do not tolerate or have inadequate response to combination therapy of a triptan and an NSAID or acetaminophen 1.
- It is also essential to avoid using opioids or butalbital for the treatment of acute episodic migraine, as they are not recommended by the American College of Physicians 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Migraine Cocktail
- A migraine cocktail is not a standardized treatment, but rather a combination of medications used to treat acute migraine attacks 2, 3, 4, 5, 6
- The choice of medications for a migraine cocktail depends on various factors, including the severity of the attack, the presence of nausea and vomiting, and the patient's medical history and contraindications 2, 3, 6
- Common components of a migraine cocktail may include:
- Triptans, such as sumatriptan, which are effective for moderate to severe migraine attacks 2, 3, 5, 6
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, which are effective for mild to moderate migraine attacks 2, 3, 6
- Antiemetics, such as metoclopramide, which can help relieve nausea and vomiting 4, 6
- Acetaminophen, which can be used in combination with other medications or as a single agent for mild to moderate migraine attacks 2, 3, 6
- The combination of sumatriptan and metoclopramide has been shown to be effective in some patients who do not respond to triptans alone 4
- Other medications, such as dihydroergotamine, ergot derivatives, and corticosteroids, may also be used in a migraine cocktail, depending on the specific needs of the patient 2, 3, 5, 6
- It is essential to individualize treatment and tailor the migraine cocktail to the patient's specific clinical features and medical history 2, 3, 5, 6