Vistaril (Hydroxyzine) for Migraine Treatment
Vistaril (hydroxyzine) is not recommended for migraine treatment based on current clinical guidelines and lacks evidence of efficacy for this indication. 1
Why Hydroxyzine Is Not Recommended for Migraines
No guideline support: The most recent 2025 American College of Physicians clinical guideline on migraine prevention does not include hydroxyzine among recommended pharmacologic treatments 1
Absence from acute treatment algorithms: The American Academy of Family Physicians and American College of Neurology guidelines for acute migraine management do not list hydroxyzine as a treatment option 1, 2, 3, 4
Limited and negative evidence: A 1987 emergency department study specifically tested hydroxyzine 50 mg for severe headache and found it was not significantly more effective than placebo for either classic migraine or other headache types 5
No synergistic benefit: The same study found that combining hydroxyzine with nalbuphine (an opioid) provided no additional benefit over nalbuphine alone, contradicting the common practice of adding hydroxyzine for presumed synergistic effects 5
What Should Be Used Instead
For Acute Migraine Treatment:
Mild to moderate attacks: NSAIDs (aspirin, ibuprofen, naproxen sodium, diclofenac) or combination therapy with acetaminophen plus aspirin plus caffeine 1, 2
Moderate to severe attacks: Triptans (sumatriptan, rizatriptan, zolmitriptan, naratriptan) are the migraine-specific agents of choice 1, 4, 6
With nausea/vomiting: Use non-oral routes of administration; metoclopramide or prochlorperazine for nausea control 1
For Migraine Prevention:
First-line agents: Propranolol, timolol, amitriptyline, topiramate, or divalproex sodium 1, 7
Consider prevention when patients have ≥2 migraine days per month with significant disability 4
Clinical Context
Hydroxyzine is an antihistamine with established use for generalized anxiety disorder 8, but this does not translate to migraine efficacy. The medication's sedating properties may have led to historical empiric use in emergency settings, but controlled evidence does not support this practice 5.