Podcast 531:  Migraine Cocktail 

<p><strong>Contributor: Don Stader, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style="font-weight: 400;">The classic migraine cocktail includes: Reglan (or other dopamine antagonist), Benadryl, Toradol, Decadron, and IV fluids. </span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">The most effective agent in the cocktail is a dopaminergic agent </span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Routine IV fluids have not shown efficacy </span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">There is no evidence for pre-treatment of akathisia with diphenhydramine (Benadryl)</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Decadron reduces rebound headache </span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Consider trigger point injections for those with migraine attributable to cervical neck pain. </span></li> </ul> <p><strong>References</strong></p> <p><span style="color: #000000;"><a style="color: #000000;" href= "https://www.ncbi.nlm.nih.gov/pubmed/?term=Jones%20CW%5BAuthor%5D&cauthor=true&cauthor_uid=30665504"> <span style="font-weight: 400;"><span style= "font-size: 10pt;">Jones CW</span></span></a></span><span style= "font-size: 10pt;"><span style="color: #000000;"><span style= "font-weight: 400;">,</span> <a style="color: #000000;" href= "https://www.ncbi.nlm.nih.gov/pubmed/?term=Remboski%20LB%5BAuthor%5D&cauthor=true&cauthor_uid=30665504"> <span style="font-weight: 400;">Remboski LB</span></a><span style= "font-weight: 400;">,</span> <a style="color: #000000;" href= "https://www.ncbi.nlm.nih.gov/pubmed/?term=Freeze%20B%5BAuthor%5D&cauthor=true&cauthor_uid=30665504"> <span style="font-weight: 400;">Freeze B</span></a><span style= "font-weight: 400;">,</span> <a style="color: #000000;" href= "https://www.ncbi.nlm.nih.gov/pubmed/?term=Braz%20VA%5BAuthor%5D&cauthor=true&cauthor_uid=30665504"> <span style="font-weight: 400;">Braz VA</span><