If you’ve ever had a migraine, you know how painful and disruptive it can be, making it difficult or even impossible to make it through your day. You might feel a throbbing headache, sensitivity to light and sound, nausea, and even dizziness. When over-the-counter pain relievers don’t help, many people look for something stronger—like a “migraine cocktail.” In this article, we’ll break down what’s in a migraine cocktail, when it’s used, and whether it’s the right option for you.
What is a migraine cocktail?
A migraine cocktail is a mix of medications used to treat a migraine attack. It's not a fancy drink — it’s just a nickname for combining drugs that work together to relieve migraine symptoms. Migraines are complicated, and sometimes, using multiple medications can help to target both causes and symptoms to help you find relief.
Migraine cocktails are often given in emergency rooms or urgent care clinics to people with severe, long-lasting, or treatment-resistant migraines. Sometimes, people create their own version at home using over-the-counter medications.
Migraine cocktails can work to:
- Stop the migraine pain
- Relieve nausea or vomiting
- Reduce inflammation
- Rehydrate the body
Depending on where you receive the treatment (hospital, clinic, or at home), the combination and dosage of your migraine cocktail can vary. Pro tip: if you find a migraine cocktail that works well for you, be sure to write down the medications and dosages, and carry it with you in your wallet or purse. If you get a migraine attack when you're out of town, this can help emergency room staff members provide the treatment you need without guessing what dosage of medications will work best for your unique treatment needs.
Are migraine cocktails safe?
Migraine cocktails can be very effective, but safety depends on a few things:
- Where you get the cocktail (ER vs. at home)
- The drugs included in the cocktail
- Your personal health history
- Other medications you’re taking
When given by a doctor or nurse in the emergency room, migraine cocktails are generally safe and closely monitored. Medical professionals check your vitals, watch for side effects, and adjust medications if needed. This is the safest way to receive a cocktail, especially if you’ve never had one before.
People sometimes try at-home versions using over-the-counter drugs like Excedrin or combinations of pain relievers and anti-nausea medicine. While this may work for some, mixing medications on your own can carry risks, especially if you:
- Take more than the recommended dose
- Mix drugs that shouldn’t be combined
- Have liver or kidney issues
- Are pregnant or nursing
- Take prescription medications
So, while migraine cocktails can be safe, it’s important to talk to your doctor first, especially if you're planning to mix medications at home.
Emergency room migraine cocktail components
Let’s look at what’s usually in a hospital-grade migraine cocktail. These medications work together to relieve migraine symptoms quickly and effectively.
Triptans
Triptans are prescription drugs designed to stop migraines once they’ve started. They work by narrowing blood vessels in the brain and blocking pain pathways.
Common triptans include:
- Sumatriptan (Imitrex)
- Rizatriptan (Maxalt)
- Zolmitriptan (Zomig)
Triptans are generally safe, but not for everyone. They can raise blood pressure and may not be suitable for people with heart disease, stroke risk, or certain circulation problems.
Antiemetics (Anti-Nausea Medications)
Migraines often come with nausea or vomiting. Antiemetics help control these symptoms. Some also reduce migraine pain and improve how well other drugs work.
Common antiemetics include:
- Metoclopramide (Reglan)
- Prochlorperazine (Compazine)
- Ondansetron (Zofran)
These drugs are usually safe, but they can cause side effects like drowsiness or restlessness. In rare cases, people may have muscle spasms or allergic reactions.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
NSAIDs help reduce pain and inflammation, and are identical or similar to drugs that you would purchase for pain relief over the counter at a drugstore.
NSAIDs commonly used in migraine cocktails include:
- Ketorolac (Toradol)
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve)
NSAIDs are effective, but using them too often or at high doses can cause stomach ulcers, kidney problems, and an increased risk of problematic bleeding. If you have a history of ulcers, bleeding issues, or kidney disease, your doctor might avoid using NSAIDs.
Magnesium
Magnesium sulfate is sometimes added to migraine cocktails, especially for people with menstrual migraines or migraines with aura. Magnesium is a mineral that helps relax blood vessels and reduce brain inflammation.
It’s usually given by IV and has very few side effects. Some people may feel flushed or warm during the infusion, but this goes away quickly. Magnesium is considered safe and well-tolerated by most people.
IV Fluids
Migraines can dehydrate you, especially if you’ve been vomiting. IV fluids help rehydrate the body and support better absorption of medications.
There are no risks to IV fluids for most people unless you have certain heart or kidney conditions that affect fluid balance. In those cases, your medical team will adjust the amount given.
Over-the-counter migraine cocktails
Not everyone goes to the ER for migraine relief. Some people use over-the-counter (OTC) drugs to make their own migraine cocktail at home. Excedrin Migraine is one of the most commonly used medications in OTC migraine cocktails.
What’s in Excedrin?
Excedrin Migraine contains:
- Aspirin (250 mg) – an NSAID that reduces pain and inflammation
- Acetaminophen (250 mg) – a pain reliever
- Caffeine (65 mg) – helps medications work faster and constricts blood vessels in the brain
This combo is FDA-approved for treating migraines and works well for many people when taken at the first sign of a migraine.
Is Excedrin Safe?
Yes, but only when used correctly.
Taking too much can lead to serious health problems, including:
- Liver damage (from too much acetaminophen)
- Stomach bleeding (from too much aspirin)
- Increased heart rate, anxiety, or insomnia (from too much caffeine)
To stay safe:
- Don’t take more than the label recommends
- Avoid mixing with other meds that contain aspirin, acetaminophen, or caffeine
- Don’t drink alcohol when using it
- Talk to your doctor if you’re on blood thinners, have liver issues, or are pregnant
Other OTC Options
Some people make their own cocktail using:
- Ibuprofen (Advil) or naproxen (Aleve)
- Acetaminophen (Tylenol)
- Caffeine pills or a strong cup of coffee
This can be helpful if you don't have Excedrin or can’t tolerate aspirin. Still, it’s best to ask a healthcare provider before trying this mix, especially if you’re unsure about dosing or safety.
Safety tips for taking a migraine cocktail
Whether you’re in the ER or at home, here are some general safety tips to keep in mind:
- Know your medications: Always check the labels of what you're taking. Many OTC and prescription drugs contain similar ingredients, especially acetaminophen or NSAIDs, and taking more than one product can easily lead to an overdose.
- Stick to the recommended dosage: Taking more won’t make the pain go away faster—it will only increase your risk of side effects or serious complications.
- Avoid frequent use: Migraine cocktails aren’t meant for daily use. Using them too often can lead to rebound headaches, also known as medication overuse headaches. This means the drugs can actually make your migraines worse over time.
- Talk to a doctor first: If you get frequent or severe migraines, you might need preventive treatment. A doctor can help create a safer, long-term plan. You might also need testing to rule out other medical problems.
- Watch for side effects: Even safe medications can cause problems in some people. Call a doctor or go to the ER if you notice trouble breathing, chest pain, severe dizziness, confusion, uncontrolled vomiting, or signs of an allergic reaction.
Download Evidation and start using MigraineSmart today
Migraines can make it tough to enjoy your day-to-day life. Understanding your triggers and tracking your symptoms can help you better understand the causes of your migraines, allowing you to lessen the frequency and severity of attacks. When you download the Evidation app, you'll be able to share the health-related data you're already tracking. We'll use this information to provide you with personalized insights that can help you better understand health issues, allowing you to take steps that can help you become your happiest, healthiest self.
You'll also gain access to our MigraineSmart tool, which will allow you to track symptoms and identify triggers, providing valuable information to both you and your healthcare provider that can help you manage migraines. Click here to learn more about Evidation and MigraineSmart and get started today.
