For a migraine attack that has not broken with oral medication — or where nausea and vomiting make swallowing anything pointless.
Why intravenous rather than oral
Migraine slows gastric emptying. That is part of the disease, not a side effect of it, and it means a tablet taken several hours into an attack may sit in the stomach largely unabsorbed. Vomiting removes the option entirely. Giving the same drug classes intravenously takes absorption out of the equation and puts the full dose where it can work within minutes.
What goes into the infusion
The combination is chosen for your attack rather than issued as a fixed recipe, but it is generally drawn from four components:
- An anti-nausea agent such as metoclopramide or prochlorperazine. These are not only for the nausea — the dopamine-blocking antiemetics have a genuine effect on migraine pain itself, which is why they are a mainstay of acute treatment rather than an afterthought.
- Fluids, where vomiting or poor intake has left you dry. Hydration alone rarely aborts a migraine, and we will not tell you it does.
- Magnesium, which has its clearest evidence in migraine with aura and in patients who are genuinely deficient.
- An anti-inflammatory such as ketorolac, and in some cases a single dose of dexamethasone — the latter given specifically to reduce the chance of the headache returning over the next day or two.
What it does not include
No opioids. Opioids are not effective migraine treatment, they interfere with the drugs that are, and repeated use converts episodic migraine into a more frequent and more treatment-resistant pattern. See migraine treatment for how that rebound cycle develops and how it is unwound.
What the visit is like
You are in a chair, not a bed. An IV is placed, the infusion runs, and most people are here somewhere between one and two hours. Metoclopramide and prochlorperazine can cause restlessness in a minority of people; we watch for it and can treat it directly if it appears. You are not sedated and you can drive yourself home unless we tell you otherwise.