From the Guidelines
A migraine cocktail typically includes a combination of medications to treat severe migraine attacks, with the most common components being a non-steroidal anti-inflammatory drug (NSAID) like ketorolac (30-60mg) or ibuprofen (600-800mg), an antiemetic such as metoclopramide (10mg) or prochlorperazine (10mg), and a diphenhydramine (25-50mg) to reduce side effects from the antiemetics, as recommended by the American College of Physicians in 2025 1.
Migraine Cocktail Components
The specific combination of medications in a migraine cocktail may vary based on individual patient needs, medical history, and the severity of the migraine attack. Some common components include:
- NSAIDs like ketorolac or ibuprofen to reduce inflammation and pain
- Antiemetics like metoclopramide or prochlorperazine to help with nausea and enhance absorption of other medications
- Diphenhydramine to prevent extrapyramidal side effects from antiemetics
- Intravenous fluids for rehydration and magnesium sulfate (1-2g) in some cases
- Triptans like sumatriptan (6mg subcutaneous or 50-100mg oral) or neuroleptics like haloperidol (2.5-5mg) in emergency settings
Treatment Approach
The American College of Physicians recommends starting treatment of migraine headache as soon as possible after its onset, using combination therapy (such as a triptan with an NSAID or acetaminophen) to improve efficacy 1. Patients should be aware of medication overuse headache and the importance of lifestyle modifications, including staying well hydrated, maintaining regular meals, securing sufficient and consistent sleep, engaging in regular physical activity, and managing stress.
Key Considerations
- Choice of a specific NSAID or triptan should be based on individualized decision making, taking into consideration patient preferences on such factors as route of administration and cost 1.
- Patients who do not tolerate or have inadequate response to a recommended migraine treatment may respond to another within the same drug class 1.
- CGRP antagonists-gepants (rimegepant, ubrogepant, or zavegepant) or ergot alkaloid (dihydroergotamine) may be considered to treat 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.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Migraine Cocktail Medications
The migraine cocktail is a combination of medications used to treat migraine headaches. The specific medications included in the cocktail may vary, but some common components are:
- Metoclopramide: an antiemetic that also has pain-relieving effects for migraine, as seen in studies 2, 3, 4, 5
- Sumatriptan: a triptan that is commonly used to treat migraine headaches, as discussed in studies 2, 3, 6, 4, 5
- Other medications: such as analgesics, ergotamine, or dihydroergotamine, may also be included in the cocktail, as mentioned in study 6
Dosages and Administration
The dosages and administration routes of the medications in the migraine cocktail may vary. For example:
- Metoclopramide: 10 mg intravenously (IV) 2, 4 or 10 mg orally 3
- Sumatriptan: 3 mg subcutaneously (SQ) 2, 4 or 50 mg orally 3
Efficacy and Comparison
Studies have compared the efficacy of metoclopramide and sumatriptan in treating migraine headaches. For example:
- A study found that metoclopramide was not non-inferior to sumatriptan in alleviating acute migraine pain 4
- Another study suggested that combining sumatriptan with metoclopramide provided relief in some migraineurs who failed to achieve adequate relief with a triptan alone 3
- A systematic review found that both metoclopramide and sumatriptan were effective in relieving pain from migraine in adults in the Emergency Department (ED) setting, but further studies are required to explore comparable effect 5