Sometimes, migraines don’t respond to single medications. Even if all your lifestyle choices support a migraine-free existence, your migraines can still overpower your go-to pharmaceutical or OTC pill. 

In those cases, your physician or migraine specialist may recommend a migraine cocktail. As with the liquid libations of that name, a migraine cocktail is made up of two or more medications that work in tandem to tame your head pain.

Building a Better Migraine Cocktail

Migraine cocktails can be made up of either prescription or over the counter medications. The individual ingredients depend on your existing medical conditions, including your non-migraine issues. Your doctor also takes into consideration how you have reacted to various medications in the past.

The most common combination includes a triptan, NSAIDs, and anti-emetics. Each of these addresses a different symptom while reducing migraine pain and inflammation.

Whether it's prescription or not, each medication can only be taken in specific amounts and for particular amounts of time. Overdoses can harm your other organs or exacerbate your headache pain. You risk triggering rebound headaches if you aren’t careful with your medication regimen. Some painkillers and migraine treatments are worse about that than others.

Types of Medications

Everybody’s migraine is different, and they react differently to the various medical treatments available. By now, there is an entire menu of prescription drugs used to combat migraine pain. The term cocktail implies you drink it, but a typical migraine cocktail is administered as part of an IV or taken by mouth.

• Anti-emetics - while the primary use is to prevent nausea and vomiting, anti-emetics relieve pain as well. 
• Triptans - these anti-inflammatory drugs are thought to narrow blood vessels in the head, easing headache pain. There are dozens of triptans on the market.
• Ergot alkaloids - these are similar to triptans and with the same effects. 
• Non-steroidal anti-inflammatories (NSAIDs) - these are available both over the counter and as prescription medications. 
• Intravenous (IV) fluids - one of a few potential liquids in your migraine cocktail, IV fluids replace any you have lost, such as through vomiting. They can also help you avoid some side-effects of other medications in your cocktail.
• IV steroids - steroids reduce pain and inflammation and are used to treat headaches and migraines.
• IV magnesium - magnesium is a natural element that can calm migraine pain.
• IV valproic acid - valproic acid (valproate) is an anti-seizure medication that is found to be helpful in severe migraine attacks. 

Potential Side Effects

Many medications have side effects. As long as they aren’t bothersome or worse than the migraine, you can still use the drug if your physician recommends it.

• Triptans tend to cause fatigue, aches and pains, and some tightness in the jaw, neck, and chest.
• Neuroepileptics and anti-emetics can cause muscle tremors and tics or restlessness.
• NSAIDs may create stomach upset, diarrhea, or abdominal pain.
• Ergot alkaloids sometimes result in sleepiness, stomach upset, vomiting, or nausea.
• Steroids can cause dizziness, nausea, and trouble sleeping.

Migraine Cocktail Fixings

The ingredients in your cocktail are formulated just for you. Your physician will pull together the appropriate elements with your medical history in mind. What might go into your cocktail?

Triptans

As mentioned above, triptans are popular and effective migraine relievers, especially if over the counter drugs don’t help. 

Triptans restrict blood flow and block the release of a peptide chemical from your nerves that is activated during migraines (Specifically, calcitonin gene-related peptides or CGRPs.) These peptides cause your blood vessels to swell and cause a cascading inflammatory response.

Don’t worry. If one triptan doesn’t work, it’s possible another might. Acute medication triptans include:

• Almotriptan (Axert)
• Eletriptan(Relpax)
• Frovatripcan (Frova)
• Naratriptan (Amerge)
• Sumartriptan (Imitrex, Sumavel, Alsuma)
• Zolmitriptan (Zomig)

Ditans are sometimes used to replace triptans. Reyvow is an example of this type of medication (see below).

Non-Triptans

Non-triptan first-line medications include: 

• Diclofenac potassium powder (Cambia)
• Prodrin
• Timolol Maleate ophthalmic solution

New Medications

Adding to the medications your physician can choose are some new ones released this year. (2020 hasn’t been a total washout.)

• Ubrogepant (Ubrelvy)
• Rimgepant (Nurtec)
• Lasmiditan (Reyvow)

Anti-emetics

If you have nausea as a primary symptom of your migraine attacks, you may receive an anti-emetic.

• Promethazine (Phenergan)
• Prochlorperazine (Compazine)
• Metoclopramide (Reglan)
• Trimethobensamide (Tigan)
• Ondansetron (Zofran)

For Dizziness

Migraines with dizziness are also known as vestibular migraines, and can be treated with these:

• Lorazepam (Ativan)
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Alprazolam (Xanax)
• Meclizine (Dramamine)

Your doctor or the emergency room physician may choose one or more of these drugs to halt your migraine attack and treat the pain.

Your migraine cocktail may consist of one or more prescription medications along with OTC drugs and homeopathic remedies.

Other Medications

Antidepressants have been known to relieve migraines as well as treat the depression common to migraineurs. Anti-seizure medications such as valproate and Topamax, and Botox(R) can be part of a migraine cocktail regimen.

OTC Migraine Cocktails

A trio of familiar items is often taken together to attack various parts of your migraine pain and experience. Also, the combination of medications provides more relief than any individual drug by itself.

• Aspirin reduces pain and inflammation
• Acetaminophen reduces the prostaglandins in your body
• Caffeine constricts your blood vessels, rather like triptans. 

Taken all at once, aspirin, acetaminophen, and caffeine reduce inflammation, swollen blood vessels, and prostaglandins that cause the discomfort. All of these are available at your local pharmacy or grocery store. 

Be cautious about taking this OTC migraine cocktail if you are allergic to any of these drugs or if you are already taking another medication containing any of them. Children under the age of 12 should not take aspirin due to the potential for Reyes Syndrome. 

Caution

OTC medications (and prescription drugs) may not be appropriate in some circumstances. Talk to your doctor if any of these apply to you:

• You are pregnant or breastfeeding.
• You have liver disease, kidney disease, or heart disease.
• You have asthma.
• You have a history of heartburn or ulcers.
• Your head pain or migraine attack is very severe and different from a typical episode.
• If you are taking any medications containing diuretics, steroids, blood thinners, or other NSAIDs.

Aspirin, in particular, but some other medications as well, cause stomach irritation that can turn into bleeding. If you are taking a blood thinner, any bleeding may be difficult to control. Most of the drugs used to treat migraines may cause abdominal pain, diarrhea, nausea, vomiting, dizziness, or trouble sleeping. The worst is when they produce a medication overuse headache.

Last Word

Suppose you are experiencing migraines that are not responding to your current medication. In that case, your physician may determine that taking a migraine cocktail of three or more different drugs may be more effective. Be sure to tell your doctor everything you are already taking, whether it's a prescription, over the counter, homeopathic, herb-based, or other substances.

Your migraine specialist needs to know what is already in your body, so you aren't overdosed on a drug or given something that interacts badly with something you have already taken. 

Be careful of the substances you use together and contact your migraine or headache specialist before attempting a combination on your own.