If you’re one of the millions of people who suffer from chronic migraine like me, you know that traditional migraine medications or over-the-counter (OTC) options often don’t offer enough relief to treat severe migraine.
These debilitating headaches can strike without warning, causing intense pain, and are often accompanied by nausea, light sensitivity, and dizziness. YUCK!
That’s where migraine cocktails come in. But what is it and how do you know if you really need one? This post will answer all your questions about migraine cocktails, including what they are, how they work, and what to expect when you take one. Let’s dive in!
Severe migraine – Not just a headache
First, let’s look at migraines and why these attacks can have us ‘crying uncle’ for medical attention!
Migraine attacks rear their ugly head when the brain becomes over stimulated. This can occur from environmental factors, imbalances in the body, or a combination of the two. Due to a genetically disposed ‘sensitive brain’, it doesn’t take much overexcitement for a migraine to start in susceptible individuals.
And you guessed it – once the migraine attack hits we can be down up to 72 hours with debilitating pain.
Migraine – a full body attack
The entire body can be effected by migraine – not just the head. There are many malfunctioning body systems that cause symptoms such as nausea, light intolerance, inability to focus/think… to name a few!
Some migraineurs can even lose control of one side of their body, stutter their speech or not even able to talk. Since these symptoms can mimic stroke, it’s important to seek help if regular medications aren’t doing the trick!
Migraine treatment: aura vs. without aura
While there are several migraine types and symptoms, the most important first step is to determine whether the person is experiencing migraine with or without aura. (If you have an aura, you know!!)
Migraine without Aura
If the person does not have an aura, (no visual disturbances) then the first step is to try and treat the pain with OTC migraine medication or prescription migraine abortives
At-Home Treatment of Acute Migraine Without Aura
This includes popular at-home migraine therapy to treat pain and inflammation such as
- Ibuprofen (nonsteroidal anti-inflammatory drug)
- Acetaminophen (Tylenol)
- Excedrin migraine (aspirin acetaminophen and caffeine)
- Abortive prescription (triptans such as sumatriptan, eletriptan, and rizatriptan)
In most cases, a migraine cocktail is only necessary for acute migraine pain that is not relieved by over-the-counter medication or triptans – a prescription abortive medication for the treatment of migraine.
Migraine with Aura
Aura refers to sensory disturbances that can precede or accompany a migraine, such as visual changes and dizziness. If the person has a migraine with aura, often the best course of action is to head to the emergency room.
Individuals who experience aura are more likely to not respond to treatment.
What exactly is a migraine cocktail?
The term ‘migraine cocktail’ comes from the unique combination of medications and treatment to help patients manage out-of-control migraine attacks via an IV. They are designed to relieve the pain of a migraine plus a lot of the nasty associated symptoms just mentioned.
In addition to preventing further attacks, this intravenous (IV) may help your frequency of migraine attacks in days to come. Hallelujah!
What are the ingredients of a migraine cocktail?
The exact ingredients of a migraine cocktail in the ER will vary depending on the health of the recipient, but it typically includes:
- Hospital-grade IV medication for pain relief (Toradol, Tylenol 3, Demerol)
- Anti-inflammatory drugs (NSAIDS)
- IV Valproic acid (VPA)
- Dihydroergotamine (DHE)
- Anti-nausea medication (Zofran)
- Diphenhydramine (Benadryl)
- Ergot alkaloids (Similar to triptans – narrowing blood vessels to help with pain)
- IV steroids
- IV fluids
- IV sedative (Ketamine)
- Vitamins: magnesium and b-12
Not quite a margarita with salt… but it can definitely feel like sweet bliss if you’re battling an ‘I want to die’ type of headache pain!
Migraine in the emergency room
Migraine cocktails offer relief from migraine symptoms by targeting different areas of the brain with specific medical combinations. Note: Most clinical environments and ERs do NOT offer or provide opioids as part of migraine cocktails anymore. Hence, the opioid epidemic!
However, patients often have to do a urinary analysis (UA) before receiving a migraine cocktail. (I had to do this the last time I landed in the emergency department at my headache clinic!)
This is to ensure the patient is not only on other problematic medications but also to check the overall health in advance.
When to head to the ER?
Both types of migraines (with or without aura) are time-sensitive conditions that requires quick and effective treatment. If your symptoms are getting worse and you’ve already tired OTC migraine meds, abortives and at home therapies such as icing & sleep … it might be time to head to the emergency department.
Especially, if you’re nauseasted and can’t keep food down any longer – then IV fluids are the best way to re-hydrate your body with all the electrolytes and minerals lost. (Not to mention a combination of medications to help with pain and inflammation!)
According to the Centers for Disease Control & Prevention (CDC), migraines are often treated in the emergency room (ER). The CDC also stated that headaches account for about 3% of all ER visits annually in the United States.
Photo by Graham Ruttan on Unsplash
Do I REALLY need a migraine cocktail?
Only you can decide when ‘enough is enough’ but if you are experiencing severe migraine symptoms such as those listed below, it might be time to make a trip.
- Nausea and vomiting
- Intense pain – throughout the head and neck
- Fever with neck stiffness
- Atypical head pain – different than the usual headache or migraine
- Neurological problems – vision changes, weakness, numbness
- Attack lasts up to or longer than 72 hours without relief
How long until I feel relief from a Migraine Cocktail?
One of the most common questions migraine headache sufferers have about getting a migraine cocktail is how long they have to wait before feeling some much-needed relief.
First, the answer depends on the severity of your migraine. Also, the number of hours since your migraine attack started has an impact on all medication effectiveness.
However, in general, patients should feel significant relief within an hour of starting IV.
According to Dr. Jessica Kiarashi, in Medical News Today, “migraine cocktails typically reduce symptoms within 60 minutes. Doctors may add one medication at a time, but typically, they administer several at once…”
Remember to help prevent migraine headaches from increasing by aborting the pain as early as possible with at-home remedies. (mentioned above)
What are the side effects a migraine cocktail?
You should be aware of some potential side effects of migraine cocktails. The most common side effect is drowsiness, so it is important not to drive or operate heavy machinery after taking one. You know, if you have a job running a bulldozer 😉
But definitely plan on getting a ride from a trusted friend or family member before and after! You will not be able to drive – and most facilities will not let you Uber home due to legal issues.
Other potential side effects besides drowsiness include:
- Dry mouth
- Low blood pressure
- Skin flushing
- Tingling in fingers & toes
- Abdominal Pain
- Et al
Personally, I have almost all of these side effects and they often last a few days after treatment. While the worst for me is constibpatin and abdominal pain, it seems like a small price to pay if it may help offer relief!
How long will a migraine cocktail last?
While migraine cocktails typically work within 30 minutes to an hour, the relief is not always long-lasting. If your migraine symptoms return after taking a migraine cocktail, another dose might be added as directed by your doctor.
Additionally, you may be prone to rebound headaches that could occur the following day(s) after a severe attack. (That’s me!)
I usually only get one full day of pain relief from a migraine cocktail (so I try and go early in the day if nothing is working at home!)
Then the following days I’ll still have head pain, but it’s much more manageable and typical of postdrome migraine symptoms, which is the last of the four stages of a migraine attack.
Typical postdrome symptoms:
- Low-grade headache
- Brain fog
- Muscle soreness
- Neck ache
The postdrome phase is often referred to as the ‘migraine hangover’ because it mimics a typical hangover! For many patients, the migrane hangover can be just as debilitating as the head pain and last for several days.
What are alternative treatments for severe migraine?
If you are looking for alternative treatments for migraines, there are a few things you can try. In addition to taking over-the-counter medications, (ibuprofen, acetaminophen) and turning to prescriptions at the sign of pain, take a look at stress management!
Many migraineurs report relaxation techniques, such as yoga or meditation, help to reduce and prevent migraine attacks. Even stepping away from and taking 5-10 minutes to lay down and breathe deeply can bring down your heart rate and dilate your blood vessels enough to ease (some) pressure.
It’s one of the most basic things you can do (that you won’t see in any medical advice columns).
For chronic migraines, preventative treatment may be necessary. If you think your migraines have turned chronic (more than 15 days per month of a migraine headache), talk to your doctor about the best course of treatment for you. There are a lot of option to consider.
Where to get Migraine Cocktails?
We’ve talked about emergency clinics, and emergency rooms at hospitals – but are there any other options? Yes!
As a matter of fact, many dedicated headache clinics are offering their own acute care for migraine cocktail medications and treatment.
Regarding medical insurance, this may be a better option than paying your emergency deductible. Note: many on-site clinics are closed on the weekends only leaving you with ER treatment on Saturdays & Sundays.
Anyone who has ever suffered from a migraine knows that they are not to be taken lightly.
One of the most effective treatments for acute migraines is what is commonly known as a “migraine cocktail” – a mixture of medications that are prescribed specifically offered to treat severe migraine.
This concoction usually includes a combination of medication to help relieve pain and nausea, as well as caffeine to help reduce inflammation. While the exact ingredients will vary depending on the person, a typical migraine cocktail might include things like ibuprofen, acetaminophen, and caffeine.
These cocktails, administered via IV, offer relief from migraines within 30-minutes to an hour, but they are not a cure-all.
The biggest side effect of migraine cocktails is that they can cause drowsiness and exhaustion. But getting some sleep is probably exactly what you need! Talk to your doctor about your own migraine cocktail options.
It’s saved me more than once and is a key piece to managing my runaway migraine pain!