Migraine Management Essential 6: Rescue Treatment

In a comprehensive Migraine management regimen, rescue treatment is an essential element. Rescue treatments are those that are used to treat Migraine attacks when abortive medications have failed or cannot be used. (See Migraine Management Essential 5: Abortive Treatment.)

No treatment is effective 100% of the time, so it’s important to have a “rescue” treatment to use when our first-line treatment fails. This should be planned and prescribed in advance so we don’t need to call our doctors, make a trip to the office, or end up in the emergency room if our abortive treatment fails us.

Rescue treatment may be one medication, a combination of medications, or a combination of medications and comfort measures such as cold packs. Medications used as rescue medications generally won’t work to abort a Migraine attack. Their purpose is to give us relief from the headache and other symptoms until the Migraine attack ends and to do so at home, keeping us out of the emergency room.

Prescription strength nonsteroidal anti-inflammatory drugs (NSAIDs) are very commonly used as rescue medications. These include:

  • indomethacin (Indocin),
  • ketorolac (Toradol),
  • ketoprofen (Orudis),
  • meloxicam (Mobic),
  • diclofenac potassium (Cataflam, Cambia) (Cambia is a new brand name of diclofenac potassium that comes in a powder that’s mixed with water to be taken so that it works more quickly than tablets. It has been FDA approved for the acute treatment of Migraine.), and
  • others.

Muscle relaxants are another type of medication often used as rescue medications. These include:

  • baclofen (Lioresal),
  • carisoprodol (Soma),
  • cyclobenzaprine (Flexeril),
  • methocarbamol (Robaxin),
  • tizanidine (Zanaflex), and
  • others.


Since nausea and vomiting are such common Migraine symptoms, medications to treat nausea are often used, alone or in combination with other medications. These include:

  • metoclopramide (Reglan),
  • ondansetron (Zofran),
  • prochlorperazine (Compazine),
  • promethazine (Phenergan), and
  • others.

Because research has shown that any use of opioids or barbiturates increases the risk of developing transformed Migraine, many doctors prefer to reserve the use of opioid pain relievers and barbiturates for use when other options have failed. They are, however, sometimes used as rescue treatments and include:

  • compound medications with acetaminophen and codeine, hydrocodone, or oxycodone (Vidodin, Percocet);
  • compound medications with butalbital (Fioricet, Fiorinal, Esgic);
  • butorphanol (Stadol);
  • hydromorphone (Dilaudid);
  • meperidine (Demerol);
  • nalbuphine (Nubain); and
  • others.

As with many other elements of Migraine and Migraine treatment, rescue treatment can vary widely from one Migraineur to another and from one doctor to another. There are other types of medications that can be used as rescue treatments as well, depending on the preferences of both doctor and patient, including:

  • medications for anxiety,
  • sleep aids,
  • antihistamines, and
  • others.

Depending on your and your doctor’s preferences, what works for you, and your needs, rescue medications may be oral, suppository, nasal spray, or injectable. What’s important is that we have a rescue plan and treatment devised and in place before they’re needed.

If you haven’t been working with your current doctor very long, don’t be surprised if (s)he isn’t ready to work on rescue treatment with you. Selecting the right rescue treatment requires some experience with us and how we respond to treatments. It takes some time for our doctors to know which types of treatments we can handle too. Some of us can handle injecting ourselves, some don’t do so well. That said, rescue treatment is something our doctors should be willing to discuss from the beginning of our treatment, even if they’re not ready to choose rescue treatments until they’ve worked with us for a period of time.

It’s important to note that rescue treatments don’t always take the place of seeing a doctor or making a trip to the emergency room. If you’re having the worst Migraine ever, or if you’re experiencing new or frightening symptoms, it’s best to call your doctor or be checked out in the emergency room or an urgent care center.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (28)
  • cborman
    6 months ago

    I am seeking Tx advice with my Daughter, who has suffered from Chronic Migranes for years(she is now 25). She has tried Rx Tx(eg-over counter NSAID, Rx-Toradol, etc) to no long-term relief. She has aggressively pursued the advice and medical assistance in the medical community, however, her last effort with the “Head of Neurosurgery” was futile. He summarized he options as, you have to exhaust all options(eg-high level narcotics he prescribed last week! Scheduled drugs that she cant drive while taking…) prior to even admin of Botox as as an alternative Tx.She feels frustrated and defeated. Her migranes make it impossible to study or work.

  • Sreagin
    3 years ago

    Toradol, phenergan and pumpkin seeds are my cocktail for migraine relief. An ER doctor told me that magnesium helps the body metabolize the meds quicker and better. So I eat the pumpkin seeds for the magnesium. I carry them with me everywhere I go because there is no longer a slow burn to them coming on. I can tell you in a matter of minutes. Perfume, air freshener, lotions, all can trigger. But sometimes no trigger just pain. Thankfully only 1 or so a month.

  • MNW
    5 years ago

    I’ve tried most of these. DHE helps me the most but the compound my Doctor prescribes me is very expensive and my insurance will do anything to get out of paying it. I’m seeing a migraine specialist but she doesn’t give out any pain meds, even as a last resort. So I have $500 in hospital bills from having to go to the ER. It’s very frustrating.

  • Teri-Robert author
    7 years ago

    Sorry you’re having such a tough time, but glad you found some meds here that you haven’t tried yet. That’s great! Even better is that I listed some types of meds here, so there are several options within those types. You are very welcome for anything we can do to help, always. Remember, you’re definitely not alone with this disease. We’re here for you.

  • taralane
    7 years ago

    There are only a few meds listed that I have not taken, but I am surprised to find more than one, because I have taken so many that I have either not worked, worked only once, or my body has rejected after a time. I am going to give my doc a list of these because I am always looking for rescue meds to try. I am in the middle of a very bad episode now, and am on a double Medrol dose which is doing nothing. I am in the 2nd day of excruciating pain, and just hoping the Medrol will kick in at some point soon. Ice on my head, and in the dark, I will relay the new meds to my doc as soon as possible. Thanks Teri for you input, once again. You are the best!

  • Darlene Jerman Rose
    7 years ago

    I think I read here somewhere, too much calcium can cause migraines? Is that true?

  • Irene Canel Petersen
    8 years ago

    have you heard of a direct relationship between dhea and calcium-if calcium is too high dhea may be low and directly contribute to migraine headache?

  • Teri Robert
    8 years ago

    Kim, to me, it’s time to go to the ER if everything I have at home has failed and I still have the Migraine. The purpose of rescue medications is to try to stay out of the ER. So, I have my triptan that I take. If that doesn’t work, I take a second dose. If that fails too, I have an oral pain medication to take for rescue. If that fails too, I have two injectable medications to use at home. If it gets to that point, yes, they give me IV medications that do help.

  • Kim Jones
    8 years ago

    how do i get injectable medications to use at home. I am a nurse and have no problem with givning myself an injection to stay out of the er.
    I think I mentioned before that none of the topomax, (triptan im allergic to) or other amino acids give me any releif. I try to use excersise ( gardening) or quiet hot baths and meditation (when I can ) to ease my pain but it just gets worse and worse as the days go by. I ususaly am in a desparate state after 3 days and break down begging the er for help.
    This is humiliating and not my idea of migraine management. What else is there out ther for me? Im 44 and my migraines started around 18 and i still have not found a medicince that can help me at home.
    🙁

  • Teri Robert
    8 years ago

    Kittens, getting three or four days relief may mean that the cycle is broken, but you’re getting another bad Migraine. Is your doctor working with you on finding an effective preventive regimen?

  • Kittens Austin
    8 years ago

    Hi..I just joined Teri’s fb page and it’s wonderful…the only thing I have been getting for shots is Sumatriptan but I usually take the pill from and can only take it 3 x a week…When I get the mind exploding ones WORSE than the shots I have to go in for infusions…IV drips and they put a cocktail of Torodol, Reglan, Magnesium…but it only lasts for like 3 or 4 days and once again BACK with a migraine! That’s what he suggested to break the cycle?

  • Karen Stanley Haack
    8 years ago

    We go to the ER when Sami has trouble walking from her migraine. She has tried every drug for migraines and nothing seems to work. She hates the ER but Toradol does get rid of her migraine in about 30 minutes.

  • Kim Salay Chajkowski
    8 years ago

    My question is when do you think it’s time to go to the ER? Is it pain level or how long you have had the headache? Do they give you meds that help, really?

  • Kim Jones
    8 years ago

    Thank you so much for inquireing about my health. I will copy and post what I replied to up top. Still, I suffer an attack at least once a month that disables me for a week ususaly. Not a very productive way of life and I would love so much to change that. : How do i get injectable medications to use at home. I am a nurse and have no problem with givning myself an injection to stay out of the er.
    I think I mentioned before that none of the topomax, (triptan im allergic to) or other amino acids give me any releif. I try to use excersise ( gardening) or quiet hot baths and meditation (when I can ) to ease my pain but it just gets worse and worse as the days go by. I ususaly am in a desparate state after 3 days and break down begging the er for help.
    This is humiliating and not my idea of migraine management. What else is there out ther for me? Im 44 and my migraines started around 18 and i still have not found a medicince that can help me at home.
    🙁

  • Kim Jones
    8 years ago

    wow I just plugged in after a few months. I have had several attacks since then that landed me in the hopspital for a shot of dilauded and phenergan. I ususaly wait after 4 days of sickness to get to the point of going to the emergency room. They dont allways take me seriously as I have been suffering since my teens with this condition. I have been seeing my general doc for 15 years and he still tries to convince me that im getting sinus headaches. When I went to see a stanford neurologist I was giving severl lumbar punctures to drain extra fluid causing a psuedo tumor. They also wanted to inject botox into my brain to paralize my nerves. NO WAY in Hell am I doing that. I am a lymphoma suvivor and anydrug with tox in the name I steer far away from. It just makes sense to me. My migrianes are triggerd with stress, lack of restoritive sleep, and nitriates and alcohol. The injested poisons I have no problem staying away from, but its the stress and sleep combo that gets sick everytime. My last episode was about 3 weeks ago. I have tried tryptains, amino acids, and none of that stuff gives me any releif. Only phenergan and an injection of dilauted helps my head. Its a horrible condidtion that is so dibilitating that is has affected my professional life and family ties.
    Nobody that is not a migraine sufferer can ever understand the pain, nausea, and helplessness that I feel. I am thankful for this blog to get some support from other sufferers that will validate my condidtion.
    Peace, good health, and love to all on this happy fathers day!

  • Teri Robert
    8 years ago

    Kim, how are you and your doctor doing on finding effective preventives? How long have you been seeing your current doctor?

  • Marisol Carter
    8 years ago

    I knew it was time when the meds were not working and the pain was intolerable..I have received a shot of demerol and anti-nausea medicine in the IV and yes it works

  • Kim Salay Chajkowski
    8 years ago

    I guess because I have migraines ALL the time and my head feels like it’s going to explode more than half the month, I never go…the thought of getting in the car and facing lights leaves me in bed with meds that don’t work most of the time and darkness and ice. Thanks for your thoughts Debby, I appreciate you taking the time.

  • Deborah Dobich Marchionda
    8 years ago

    when I got my migraines, I would go when it felt like my head was going to explode and I couldn’t see. Yes they gave me IV meds and kept me in a dark room.

  • Cristina Burnham Anderson
    8 years ago

    P.S. I have had Toradol, demerol, benedryl and a few others by IV in the ER and I have noticed that they seemed to work the first couple of times but don’t anymore. I think my regemine now at the ER (which is only about 1 or twice a year) is Ativan, Compazine or Phenegren and DHE. At least that is what it was a few months ago. Good luck everyone!

  • Cristina Burnham Anderson
    8 years ago

    Good luck Karen!

  • Karen Stanley Haack
    8 years ago

    The Dr. did give Sami Ativan this time……we’ll see if it helps.

  • Cristina Burnham Anderson
    8 years ago

    I have several meds that I take together or individually in order to break a migraine or just control the pain level. When I have a very severe migraine that lasts more than 2 days that is when I start combining…my combination usually is 2 baclofen, 2 isometheptene, 2 thorazine pills and 2 indocin. That will usually break it…at least so far. If I have the migraine during the day and am unable to have a babysitter (cause I am a stay at home mom w/2 little ones) then I substitue a DHE injection for the thorazine so I won’t get drowsy. Also I may take a phenegren or compazine during the day to help w/the nauseau but only as needed. My absolute last resort before going to the ER is a zomig nasal inhaler (but I have to have x number of hrs between the zomig and DHE and thorazine); I have the after taste so that is why zomig is my last resort but it usually works great..I do only take this when I am able to lay down right away though. I take my bacoflen and iso together all the time and have to take then about 3-4 days out of every week; I take them to manage the pain of any headache and they work great together! But the iso has to be bought at a compound pharmacy which means thru the mail for me so I have to ration it until I can get my next delivery. Hope this helps someone!

  • Pen Ort
    8 years ago

    Teri thank you so much for this. I have asked why we don’t get much at all as rescue in the UK. No one has ever really offered a reason. Can it be cost perhaps?

  • Teri Robert
    8 years ago

    You’re welcome, Pen. I really can’t give you a reason why anything is or isn’t done in the UK. I suspect you’re going to have to ask someone there to answer your question. I don’t see how it would be cost though. None of my rescue medications are expensive. In fact, they’re less expensive than my triptans.

  • Yolanda Hunter Young
    8 years ago

    The first time I had an injection of Torodol it worked. It has never worked again since the first time. Has anyone tried any of the other RX ANSAIDS listed here? My husband takes one of them for elbow/hand pain, I will try it next time. Recently I was able to break a very bad 3 day migraine with Phenergan. It just makes me feel so hungover. Prior to taking it I had taken Maxalt, torodol, vicodin, Maxalt with no relief. My Dr. suggested the Phenergan to break the cycle.

  • Michelle Malley
    7 years ago

    Phenergan is just an anti-nausea Med. How did it help?

  • Lily Inayat
    7 years ago

    have you tried relpax? That stuff is amazing. I’m also on indomethacin before i go work out. and on Topirimate for preventative

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