Table of ContentsView AllTable of ContentsWhen to Seek CareTreatment Approaches in the ERFirst-Line TreatmentsSecond-Line TreatmentsMedications Not RecommendedCaution for Pregnant WomenFrequently Asked Questions

Table of ContentsView All

View All

Table of Contents

When to Seek Care

Treatment Approaches in the ER

First-Line Treatments

Second-Line Treatments

Medications Not Recommended

Caution for Pregnant Women

Frequently Asked Questions

Every 10 seconds, someone in the United States develops a migraine headache so severe they go to the hospital emergency room (ER).Given the pain and risks associated with these episodes (e.g., uncontrolled vomiting), ER doctors often opt for migraine treatments that can be administered via injection or IV to have a quick effect.

Emergencytreatment for migrainedepends on a patient’s specific symptoms and overall health and health history. The ER typically administers a combination of medications. The migraine cocktail includes a mix of non-steroidal anti-inflammatory drugs (NSAIDs), magnesium, triptans, and IV fluids.

This article provides an overview of emergency treatments for migraines and headaches, including migraine cocktails and other approaches used in the ER. Individual care may differ slightly from these standard protocols.

Sorrasak Jar Tinyo / Getty Images

Patient looking at the window with hope in the hospital

If you deal with migraines, it’s helpful to know that there are solutions if they ever get so bad as to warrant emergency care. But knowingwhento seek that level of medical attention is important.

If you would describe your pain as your worst migraine attack (or headache) ever, cal 911.

Concerning Symptoms

The treatment you might receive in a hospital emergency department for a migraine headache will be based, for the most part, on your symptoms and personal health history. In other words, there’s no one-size-fits-all migraine cocktail.

These methods allow medications to work more quickly in the body, and they are more effective for someone who’s experiencing so much nausea and/or vomiting that keeping down a pill is almost impossible. Many people are also given fluids via IV to prevent dehydration.

In 2016, the American Headache Society (AHS) put together a panel of experts to review clinical trials of the many diverse medications used in emergency settings to treat migraines in adults to determine which truly work best and are safest. The panel considered studies of 28 different medications to come up withrecommendations for the acute treatment of migraines in adults.

Based on the results of 68 clinical trials, the AHS panel determined that adults who visit the ER for migraine pain and other symptoms should be offered one or more of these three medications to treat pain and other symptoms, particularly nausea and vomiting:

The panel also determined that adults with migraine should receive a dose ofdexamethasone, a steroid that lowers the risk that a migraine will recur.

In March 2023, the Food and Drug Administration (FDA) approved Zavzpret (zavegepant) for the treatment of acute migraines with or without aura. Zavzpret is the first calcitonin gene-related peptide (CGRP) receptor antagonist administered as a nasal spray.

If for some reason the first-line medications are not appropriate, the panel found that the following alternatives may be offered in a migraine cocktail:

Medications for Treating Migraines

Among medications that have commonly been used in the ER to treat migraine headaches are a handful that the panel suggests should not be given because they don’t work as well as others or for other reasons. Hydromorphone and morphine, for example, are opioids—a class of drug associated with addiction.

On the AHS list of drugs that are best avoided for treating migraine in the ER are:

Using Migraine Medications During Pregnancy

A Word From Verywell

The most important thing to remember if you go to the ER for migraine (or any other emergency) is that you need to be an advocate for yourself or make sure someone is with you who can fill that role. This means being forthright and thorough when answering questions about your current health and any medications you take, including over-the-counter products, supplements, and recreational drugs. Your honesty will help the doctors caring for you hone in on the migraine medications most likely to relieve your pain as quickly as possible.

Frequently Asked QuestionsYes, you can go to the ER for treatment of a migraine. However, it isn’t necessary unless it is a severe migraine or associated with the following symptoms:ConfusionFeverNumbnessStiff neckWeaknessVision changesSeek immediate medical attention for a headache that comes on suddenly and reaches maximum intensity within a few minutes.A migraine cocktail is a combination of medications used to treat migraine in the ER. This can include an NSAID, dihydroergotamine, anti-nausea medication, an antihistamine, magnesium, and fluids.The exact combination of medications will vary from person to person.Yes, a common at-home migraine cocktail includes 250 mg of aspirin, 250 mg of Tylenol (acetaminophen), and 65 mg of caffeine.These are also the ingredients in Excedrin. Research shows most migraines respond to this drug combination within two hours.

Yes, you can go to the ER for treatment of a migraine. However, it isn’t necessary unless it is a severe migraine or associated with the following symptoms:ConfusionFeverNumbnessStiff neckWeaknessVision changesSeek immediate medical attention for a headache that comes on suddenly and reaches maximum intensity within a few minutes.

Yes, you can go to the ER for treatment of a migraine. However, it isn’t necessary unless it is a severe migraine or associated with the following symptoms:

Seek immediate medical attention for a headache that comes on suddenly and reaches maximum intensity within a few minutes.

A migraine cocktail is a combination of medications used to treat migraine in the ER. This can include an NSAID, dihydroergotamine, anti-nausea medication, an antihistamine, magnesium, and fluids.The exact combination of medications will vary from person to person.

Yes, a common at-home migraine cocktail includes 250 mg of aspirin, 250 mg of Tylenol (acetaminophen), and 65 mg of caffeine.These are also the ingredients in Excedrin. Research shows most migraines respond to this drug combination within two hours.

6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Migraine Research Foundation.Migraine facts.Dodson H, Bhula J, Eriksson S, Nguyen K.Migraine treatment in the emergency department: alternatives to opioids and their effectiveness in relieving migraines and reducing treatment times.Cureus. 2018;10(4):e2439. doi:10.7759/cureus.2439Andrade C.Valproate in pregnancy: recent research and regulatory responses.J Clin Psychiatry. 2018;79(3):18f12351. doi:10.4088/JCP.18f12351American Migraine Foundation.Understanding migraine treatment in the emergency room.American Migraine Foundation.Migraine cocktails: what they are and why they are misunderstood.Diener HC, Gaul C, Lehmacher W, Weiser T.Aspirin, paracetamol (acetaminophen) and caffeine for the treatment of acute migraine attacks: A systemic review and meta-analysis of randomized placebo-controlled trials.Eur J Neurol. 2022;29(1):350–7. doi:10.1111/ene.15103Additional ReadingBajwa ZH, Smith JH.Acute treatment of migraine in adults. UpToDate. Updated May 14, 2018.Friedman BW, Garber L, Yoon A, et al.Randomized trial of IV valproate vs metoclopramide vs ketorolac for acute migraine.Neurology.2014 Mar 18;82(11):976-83. doi:10.1212/WNL.0000000000000223Kostic MA, Gutierrez FJ, Rieg TS, Moore TS, Gendron RT.A prospective, randomized trial of intravenous prochlorperazine versus subcutaneous sumatriptan in acute migraine therapy in the emergency department.Ann Emerg Med. 2010 Jul;56(1):1-6. doi:10.1016/j.annemergmed.2009.11.020Orr SL, Friedman BW, Christie S, et al.Management of adults with acute migraine in the emergency department: The American Headache Society evidence assessment of parenteral pharmacotherapies.Headache. 2016;56(6):911-40. doi:10.1111/head.12835

6 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Migraine Research Foundation.Migraine facts.Dodson H, Bhula J, Eriksson S, Nguyen K.Migraine treatment in the emergency department: alternatives to opioids and their effectiveness in relieving migraines and reducing treatment times.Cureus. 2018;10(4):e2439. doi:10.7759/cureus.2439Andrade C.Valproate in pregnancy: recent research and regulatory responses.J Clin Psychiatry. 2018;79(3):18f12351. doi:10.4088/JCP.18f12351American Migraine Foundation.Understanding migraine treatment in the emergency room.American Migraine Foundation.Migraine cocktails: what they are and why they are misunderstood.Diener HC, Gaul C, Lehmacher W, Weiser T.Aspirin, paracetamol (acetaminophen) and caffeine for the treatment of acute migraine attacks: A systemic review and meta-analysis of randomized placebo-controlled trials.Eur J Neurol. 2022;29(1):350–7. doi:10.1111/ene.15103Additional ReadingBajwa ZH, Smith JH.Acute treatment of migraine in adults. UpToDate. Updated May 14, 2018.Friedman BW, Garber L, Yoon A, et al.Randomized trial of IV valproate vs metoclopramide vs ketorolac for acute migraine.Neurology.2014 Mar 18;82(11):976-83. doi:10.1212/WNL.0000000000000223Kostic MA, Gutierrez FJ, Rieg TS, Moore TS, Gendron RT.A prospective, randomized trial of intravenous prochlorperazine versus subcutaneous sumatriptan in acute migraine therapy in the emergency department.Ann Emerg Med. 2010 Jul;56(1):1-6. doi:10.1016/j.annemergmed.2009.11.020Orr SL, Friedman BW, Christie S, et al.Management of adults with acute migraine in the emergency department: The American Headache Society evidence assessment of parenteral pharmacotherapies.Headache. 2016;56(6):911-40. doi:10.1111/head.12835

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Migraine Research Foundation.Migraine facts.Dodson H, Bhula J, Eriksson S, Nguyen K.Migraine treatment in the emergency department: alternatives to opioids and their effectiveness in relieving migraines and reducing treatment times.Cureus. 2018;10(4):e2439. doi:10.7759/cureus.2439Andrade C.Valproate in pregnancy: recent research and regulatory responses.J Clin Psychiatry. 2018;79(3):18f12351. doi:10.4088/JCP.18f12351American Migraine Foundation.Understanding migraine treatment in the emergency room.American Migraine Foundation.Migraine cocktails: what they are and why they are misunderstood.Diener HC, Gaul C, Lehmacher W, Weiser T.Aspirin, paracetamol (acetaminophen) and caffeine for the treatment of acute migraine attacks: A systemic review and meta-analysis of randomized placebo-controlled trials.Eur J Neurol. 2022;29(1):350–7. doi:10.1111/ene.15103

Migraine Research Foundation.Migraine facts.

Dodson H, Bhula J, Eriksson S, Nguyen K.Migraine treatment in the emergency department: alternatives to opioids and their effectiveness in relieving migraines and reducing treatment times.Cureus. 2018;10(4):e2439. doi:10.7759/cureus.2439

Andrade C.Valproate in pregnancy: recent research and regulatory responses.J Clin Psychiatry. 2018;79(3):18f12351. doi:10.4088/JCP.18f12351

American Migraine Foundation.Understanding migraine treatment in the emergency room.

American Migraine Foundation.Migraine cocktails: what they are and why they are misunderstood.

Diener HC, Gaul C, Lehmacher W, Weiser T.Aspirin, paracetamol (acetaminophen) and caffeine for the treatment of acute migraine attacks: A systemic review and meta-analysis of randomized placebo-controlled trials.Eur J Neurol. 2022;29(1):350–7. doi:10.1111/ene.15103

Bajwa ZH, Smith JH.Acute treatment of migraine in adults. UpToDate. Updated May 14, 2018.Friedman BW, Garber L, Yoon A, et al.Randomized trial of IV valproate vs metoclopramide vs ketorolac for acute migraine.Neurology.2014 Mar 18;82(11):976-83. doi:10.1212/WNL.0000000000000223Kostic MA, Gutierrez FJ, Rieg TS, Moore TS, Gendron RT.A prospective, randomized trial of intravenous prochlorperazine versus subcutaneous sumatriptan in acute migraine therapy in the emergency department.Ann Emerg Med. 2010 Jul;56(1):1-6. doi:10.1016/j.annemergmed.2009.11.020Orr SL, Friedman BW, Christie S, et al.Management of adults with acute migraine in the emergency department: The American Headache Society evidence assessment of parenteral pharmacotherapies.Headache. 2016;56(6):911-40. doi:10.1111/head.12835

Bajwa ZH, Smith JH.Acute treatment of migraine in adults. UpToDate. Updated May 14, 2018.

Friedman BW, Garber L, Yoon A, et al.Randomized trial of IV valproate vs metoclopramide vs ketorolac for acute migraine.Neurology.2014 Mar 18;82(11):976-83. doi:10.1212/WNL.0000000000000223

Kostic MA, Gutierrez FJ, Rieg TS, Moore TS, Gendron RT.A prospective, randomized trial of intravenous prochlorperazine versus subcutaneous sumatriptan in acute migraine therapy in the emergency department.Ann Emerg Med. 2010 Jul;56(1):1-6. doi:10.1016/j.annemergmed.2009.11.020

Orr SL, Friedman BW, Christie S, et al.Management of adults with acute migraine in the emergency department: The American Headache Society evidence assessment of parenteral pharmacotherapies.Headache. 2016;56(6):911-40. doi:10.1111/head.12835

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