From the Guidelines
A migraine cocktail typically consists of a combination of medications such as NSAIDs, triptans, and antiemetics, with the most effective combination including a triptan, an NSAID, and an antiemetic. The composition of a migraine cocktail can vary depending on the specific needs of the patient and the severity of their symptoms. According to the evidence from 1, first-line therapy for migraines includes NSAIDs such as aspirin, ibuprofen, naproxen sodium, and tolfenamic acid, as well as the combination agent acetaminophen plus aspirin plus caffeine. For patients whose migraine attack has not responded to NSAIDs, the use of migraine-specific agents such as triptans (e.g. oral naratriptan, rizatriptan, and zolmitriptan) and DHE is recommended 1. Anti-emetics should also be considered, especially for patients whose migraines present early with nausea or vomiting as a significant component of the symptom complex 1. Some examples of medications that may be included in a migraine cocktail are:
- Triptans: sumatriptan (100mg orally)
- NSAIDs: ibuprofen (400-600mg) or ketorolac (30mg IV or 60mg IM)
- Anti-emetics: metoclopramide (10mg IV) or prochlorperazine (10mg IV)
- Other medications: diphenhydramine (25-50mg IV) to reduce side effects. It's essential to note that the specific composition of a migraine cocktail may vary depending on the individual patient's needs and medical history, and should be determined in consultation with a healthcare provider.
From the Research
Migraine Cocktail Composition
The composition of a migraine cocktail typically consists of medications such as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Triptans, and Anti-Emetics.
- NSAIDs:
- Triptans:
- Anti-Emetics:
- Metoclopramide
- Domperidone
- Prochlorperazine 2
Combination Therapies
Combination therapies, such as combining triptans with NSAIDs, have demonstrated better efficacy in treating migraine attacks 4. The fixed combination of sumatriptan and naproxen sodium has shown improved 2-hour and 24-hour benefits over monotherapy with each option 4.
Treatment Strategies
Acute medications can be organized into four treatment strategies for use in various clinical settings, including:
- Acetaminophen-NSAID strategy for patients with attacks of mild to moderate severity
- Triptan strategy for patients with severe attacks and for those with attacks of moderate severity who do not respond well to NSAIDs
- Refractory migraine strategies for patients who do not respond well to NSAIDs or triptans alone
- Strategies for patients with contraindications to vasoconstricting drugs 2, 3