What is the composition of a migraine cocktail, typically consisting of medications such as triptans (e.g., sumatriptan) and anti-emetics?

From the Guidelines

For the treatment of acute episodic migraine headache, a combination of medications such as a triptan and an NSAID, or acetaminophen when NSAIDs are contraindicated or not tolerated, is recommended. This approach is based on the most recent guideline from the American College of Physicians, published in 2025 1. The guideline suggests that if patients do not achieve sufficient pain relief with an NSAID or acetaminophen, a triptan can be added to the treatment regimen.

When creating a migraine cocktail, the following options can be considered:

• A triptan (such as sumatriptan, almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, or zolmitriptan)
• An NSAID (such as aspirin, celecoxib, diclofenac, ibuprofen, or naproxen)
• Acetaminophen
• A nonoral triptan and an antiemetic for people with severe nausea or vomiting

It is essential to note that the choice of a specific medication should be based on individualized decision making, taking into consideration patient preferences and factors such as route of administration and cost 1. Additionally, opioids or butalbital should not be used for the treatment of acute episodic migraine, as they are not recommended by the guideline.

For moderate to severe acute episodic migraine headache, CGRP antagonists-gepants (rimegepant, ubrogepant, or zavegepant) or ergot alkaloid (dihydroergotamine) can be considered as alternative options for nonpregnant outpatient adults who do not tolerate or have inadequate response to combination therapy of a triptan and an NSAID or acetaminophen 1. The ditan lasmiditan can also be used to treat moderate to severe acute episodic migraine headache in nonpregnant outpatient adults who do not tolerate or have inadequate response to all other pharmacologic treatments included in the guideline.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Migraine Cocktail

• A migraine cocktail is a combination of medications used to treat acute migraine attacks, and the most effective combination may vary depending on the individual patient and the severity of their symptoms 2.
• The combination of a triptan, such as sumatriptan, and a non-steroidal anti-inflammatory drug (NSAID), such as naproxen, has been shown to be effective in treating acute migraine attacks 3, 4.
• This combination has been found to be more effective than using either medication alone, with a greater percentage of patients achieving pain-free and headache relief at two hours 3.
• The use of combination therapies, including the combination of sumatriptan and naproxen, has been found to be safe and well-tolerated, with a low risk of adverse events 3, 4.
• Other medications, such as metoclopramide, may also be used in combination with other treatments to provide relief from migraine symptoms 5.
• The rationale behind using combination therapy in acute migraine treatment is to provide enhanced therapeutic benefits and fewer adverse events compared to monotherapy 6.

Treatment Options

• The choice of treatment for acute migraine attacks depends on the individual patient's symptoms, medical history, and response to previous treatments 2.
• Treatment options may include:
  • Triptans, such as sumatriptan
  • NSAIDs, such as naproxen
  • Combination therapies, such as sumatriptan and naproxen
  • Antiemetic medications, such as metoclopramide
  • Other medications, such as dopamine antagonists and corticosteroids 2, 5

Efficacy and Safety

• The efficacy and safety of combination therapies for acute migraine treatment have been studied in several clinical trials 3, 4.
• These studies have found that combination therapies, such as sumatriptan and naproxen, are effective and well-tolerated, with a low risk of adverse events 3, 4.
• The use of combination therapies may provide enhanced therapeutic benefits and fewer adverse events compared to monotherapy 6.