Migraine Cocktail Via Infusion

One of the biggest advantages to having my migraines managed by a migraine specialist this past year, rather than a primary care physician or a general neurologist, was having access to the infusion suite.

I've written before about my experience using the infusion suite.

What is an infusion suite?

In short, this space is made up of several individual patient bays used for medication infusions. It is often an option for IV migraine treatment without the need to utilize the emergency room. They treat many neurological patients in this space, some on routine infusion medications and others in migraine crises. The entire space is calm, quiet, and set up to be extremely patient-friendly, especially when you're struggling with a migraine.

When my migraine escalates past a few days of trying to manage it at home with the prescription medications and other tools I have at my disposal, I find myself reaching out to my doctor to ask for recommendations. When I've identified the migraine trigger, sometimes it's easier for him to advise on a different course of treatment to manage and even abort my migraine; other times, it may take a few rounds of adjustments to find relief.

Last month, I experienced a sudden onset of a menstrual migraine when I wasn't expecting to get my period. Luckily, I had some treatment options on hand, but I found that they only reduced the pain, they didn't eliminate it. When I called my doctor, he recommended I come in for an infusion.

What is in a migraine infusion?

A migraine infusion, also known as a migraine cocktail, is a combination of medications given via IV to combat the symptoms of a migraine.

Which medications are involved?

While different offices/treatment facilities may vary somewhat on what’s included in their migraine infusion, my experience has typically involved the following medications:¹

• IV Antihistamine (ie: Benadryl)
• IV NSAID (ie: Toradol)
• IV antiemetic (ie: Compazine/Reglan)
• IV fluids
• IV steroid
• IV Depakote
• IV magnesium

Which have the infusion suite that I've gone to used?

My clinic specifically uses the first four items routinely as the first and second line of treatment. If that isn't enough to provide adequate relief, the third round of treatment includes a repeat of the first four items along with a steroid. If the migraine persists, they use Depakote and magnesium as fourth and fifth lines of treatment.

Why get an infusion to treat an attack?

I have found infusions to be the fastest, most effective way to treat a migraine, especially one that's lingering on. Oftentimes, oral or even injection medication I have prescribed at home can "take the edge off" my migraine or pacify the symptoms for a few hours here and there. Still, the migraine itself continues to come back over and over again. With a migraine infusion, I most often experience 75-100% relief and no return of a migraine until another one is triggered.

The pros and cons

In my opinion, the benefits/pros of receiving a migraine cocktail via infusion outweigh the cons. Here's how I look at it.

Pros:

• Infusions utilize a variety of agents at once to synergistically treat and stop your migraine in action
• Someone is available to monitor and ask questions to in-person during treatment (nurse, doctor on-site)
• IV medications work faster than oral ones

Cons:

• You need to leave your home and go to a doctor's office or hospital to receive IV treatment
• An IV needs to be placed
• You may worry about insurance/cost

Have you received a migraine infusion? Has it been beneficial? Are there pros and/or cons you'd add to my list above?