Migraine Cocktail Dosing Guidelines

Sumatriptan Administration

The American Academy of Family Physicians recommends administering 6 mg of sumatriptan subcutaneously, which can be repeated after one hour if needed, with a maximum of 12 mg per 24 hours 1
The American Academy of Family Physicians suggests that subcutaneous administration is particularly effective when nausea and vomiting are prominent features 1
Administer 50-100 mg of sumatriptan orally, which can be repeated after 2 hours if needed, with a maximum of 200 mg per 24 hours 1
Administer 5-10 mg (one to two sprays) of sumatriptan intranasally in one nostril, which can be repeated after 2 hours, with a maximum of 40 mg per day 1

The American College of Physicians recommends administering 10 mg of metoclopramide intravenously as both an antiemetic and as monotherapy for acute migraine 3
Metoclopramide has fair evidence supporting its use as monotherapy for acute migraine attacks, particularly when nausea and vomiting are present 3

The American College of Physicians notes that intravenous corticosteroids are not effective as monotherapy for acute migraine, but are commonly used in clinical practice to prevent headache recurrence 3

The American Academy of Family Physicians advises against administering sumatriptan in patients with coronary artery disease or risk factors for heart disease, uncontrolled hypertension, hemiplegic or basilar migraine, recent use of ergotamine-containing medications or another triptan, concurrent MAOI use, pregnancy, or impaired hepatic function 1, 3

The American Academy of Family Physicians recommends that patients try sumatriptan for 2-3 headache episodes before abandoning this therapy, as response can vary between attacks 1
Limit acute migraine treatment to no more than twice per week to prevent medication-overuse headache 3
Approximately 40% of patients experience headache recurrence within 24 hours, which can be treated with a second dose 1
Common adverse events include injection site reactions, chest pressure and heaviness, nausea, warmth, vomiting, vertigo, and malaise 1, 2, 3