Migraine Cocktail Dosing

Metoclopramide (Reglan) Dosing

The American Academy of Family Physicians recommends administering metoclopramide 10 mg IV as the primary agent for acute migraine, with a standard dose of 10 mg IV or orally 1, 2
The American Academy of Family Physicians suggests giving metoclopramide 20-30 minutes before or with an NSAID for optimal gastric motility improvement 1
Contraindications for metoclopramide include pheochromocytoma, seizure disorder, GI bleeding, and GI obstruction, according to the American Academy of Family Physicians 1
Common adverse effects of metoclopramide include restlessness, drowsiness, diarrhea, muscle weakness, and dystonic reactions, as reported by the American Academy of Family Physicians 1

The American Academy of Family Physicians recommends administering ketorolac 60 mg IM as the standard dose for acute migraine, with a maximum daily dose of 120 mg and not exceeding 5 days of treatment 1, 2
The American Academy of Family Physicians suggests that contraindications for ketorolac include aspirin/NSAID-induced asthma, pregnancy, and cerebrovascular hemorrhage 1

The American Academy of Family Physicians recommends adding dexamethasone 4 mg IV to reduce headache recurrence after ED discharge, particularly for preventing recurrent or protracted migraine 1

The American College of Physicians suggests that if there is an inadequate response to initial treatment, consider migraine-specific agents (triptans) rather than increasing doses, as recommended by the Annals of Internal Medicine 3, 4

The American Academy of Family Physicians advises limiting acute treatment to no more than twice weekly to prevent medication-overuse headaches, with a strength of evidence supported by the American Academy of Family Physicians and the Annals of Internal Medicine 3, 5
The American Academy of Family Physicians recommends alternative NSAID options, such as ibuprofen 800 mg or naproxen sodium 550 mg orally, if ketorolac is contraindicated 1, 2
The American Academy of Family Physicians suggests prochlorperazine 25 mg orally or suppository as an alternative to metoclopramide, with a maximum of 3 doses per 24 hours 1, 2