Avamigran is a migraine abortive medication combining ergotamine tartrate with caffeine. Ergotamine constricts dilated cranial blood vessels and modulates neurotransmission associated with migraine pain, while caffeine enhances absorption and augments analgesic effects. This pairing has been used for decades to stop an attack in progress, especially when taken early in the prodrome or at headache onset.
Primary indication: acute treatment of migraine with or without aura. Some clinicians also consider ergotamine-containing products in select cases of cluster headache, but this is off-label in many regions and requires specialist guidance. Avamigran is not intended for daily use or prevention; overuse increases the risk of rebound or medication-overuse headache.
How it compares: Many patients today try triptans or newer CGRP-pathway agents first due to convenience and safety profiles. However, when those are not tolerated or contraindicated, ergotamine–caffeine combinations like Avamigran can be an option under medical supervision, provided vascular risk factors are carefully evaluated.
Always follow the exact dosing on your local Avamigran package insert and your prescriber’s instructions, as tablet strengths and national guidelines can vary. The general principle is to take Avamigran at the first sign of migraine (aura or headache onset), not as a preventative.
Typical adult use (reference pattern for ergotamine–caffeine combinations): At onset, take an initial dose, then if needed, repeat at specified intervals until relief or up to the manufacturer’s maximum. Many brands advise not exceeding a maximum number of tablets per attack (commonly up to 6) and a weekly cap (often up to 10). Your specific Avamigran product may differ; read your label closely.
Key dosing safeguards: Do not exceed the per-attack or weekly maximums. Do not use daily. If you need acute medication more than 2–3 days per week, discuss a preventive strategy with your clinician to avoid medication-overuse headache. Do not use Avamigran within 24 hours of a triptan or another ergot-containing drug due to additive vasoconstriction.
Administration tips: Taking Avamigran at the earliest symptom often improves effectiveness. Some patients take it with water and food to minimize nausea. If nausea/vomiting is prominent, an antiemetic prescribed by your clinician may help ensure absorption. Avoid alcohol and nicotine around dosing, as they can worsen vasoconstriction and side effects.
Cardiovascular risk: Because ergotamine is a potent vasoconstrictor, a cardiovascular risk assessment is essential. Patients with risk factors for coronary artery disease (e.g., older age, diabetes, hypertension, hyperlipidemia, smoking, strong family history) should be evaluated cautiously, and alternative migraine treatments may be preferred.
Pregnancy and breastfeeding: Ergotamine is contraindicated in pregnancy due to uterotonic and vasoconstrictive effects and the risk of fetal harm. It can also suppress lactation and may be excreted in breast milk; avoid during breastfeeding unless a specialist explicitly advises otherwise.
Organ impairment: Use is generally not recommended in significant hepatic or renal impairment, or in systemic infections (sepsis). Elderly patients may be more sensitive to vasoconstrictive effects and should be monitored closely if prescribed.
Migraine subtype: Do not use in hemiplegic or basilar/brainstem migraine variants without specialist oversight. For frequent attacks, discuss preventive therapies (e.g., CGRP monoclonal antibodies or gepants, beta-blockers, topiramate), which can reduce attack frequency and the need for acute medications like Avamigran.
Lifestyle factors: Smoking and nicotine exposure can amplify vasoconstriction risk; cessation is strongly advised, particularly if using ergotamine. Grapefruit products should be avoided due to potential CYP3A4 interaction that can dangerously increase ergotamine levels.
Medication-overuse headache: Limit acute treatment days and track usage. If you find Avamigran increasingly less effective or need it frequently, speak with your provider about detox strategies and preventive options.
Do not use Avamigran if you have any of the following, unless a specialist explicitly determines otherwise:
- Known coronary artery disease, peripheral arterial disease, cerebrovascular disease, or uncontrolled hypertension.
- Severe hepatic or renal impairment, sepsis, or systemic infections.
- Pregnancy or breastfeeding.
- Hemiplegic or basilar/brainstem migraine, or a history of severe ischemic events linked to vasoconstrictors.
- Hypersensitivity to ergot alkaloids, caffeine, or excipients in the formulation.
- Concomitant use with potent CYP3A4 inhibitors (e.g., certain macrolide antibiotics, protease inhibitors, some azole antifungals) due to risk of life-threatening ischemia—this is a boxed/strong warning in ergotamine labeling.
- Concomitant use with triptans or other ergots within 24 hours (additive vasoconstriction).
Common: Nausea, vomiting, stomach upset, dizziness, flushing, jitteriness (from caffeine), and fatigue. Taking with light food and adequate hydration may reduce GI symptoms.
Vasoconstrictive effects: Cold or numb fingers/toes, muscle pain, tingling, reduced peripheral pulses, or color changes in extremities. If you notice severe or persistent symptoms, stop the medication and seek medical advice promptly.
Serious (seek urgent care): Chest pain or tightness, shortness of breath, severe abdominal pain, sudden weakness or confusion, slurred speech, vision changes, severe hypertension, fainting, or signs of limb ischemia (pale, cold, painful limb). These may signal excessive vasoconstriction or vascular events.
Ergotism (overdose/toxicity): Severe vasospasm leading to ischemia, tingling progressing to pain, cyanosis, persistent numbness, and in extreme cases tissue damage. This is a medical emergency.
Long-term risks: Frequent use can cause medication-overuse headache and diminished responsiveness. Work with your clinician to optimize preventive therapy and limit acute-use days.
CYP3A4 inhibitors (strong): Erythromycin, clarithromycin, ritonavir and other HIV protease inhibitors, some azole antifungals (e.g., itraconazole, ketoconazole). These can markedly increase ergotamine levels and precipitate life-threatening ischemia. Do not combine.
Other vasoconstrictors: Triptans, additional ergot alkaloids, certain decongestants (e.g., high-dose pseudoephedrine) increase vasospastic risk. Avoid triptans within 24 hours of Avamigran.
Beta-blockers: Propranolol and other beta-blockers may potentiate peripheral vasoconstriction with ergotamine; combination requires careful risk–benefit consideration by a clinician.
Nicotine and smoking: Additive vasoconstriction increases adverse event risk; smoking cessation is strongly advised.
Grapefruit/grapefruit juice: Can inhibit CYP3A4 and elevate ergotamine exposure; avoid.
Caffeine sources: Avamigran already contains caffeine. Combining with additional high-caffeine products can increase jitteriness, palpitations, and sleep disturbance.
Always provide your clinician and pharmacist a full list of prescription drugs, OTC medications, vitamins, and herbal supplements (e.g., St. John’s wort) to screen for interactions.
Avamigran is taken as needed at migraine onset; there is no “scheduled” dose. If you did not take it early and the headache is already severe, discuss alternative rescue strategies with your clinician (e.g., an antiemetic, NSAID, a triptan on a different day, or a clinic-administered option). Do not “double up” later the same day if you have reached the per-attack maximum. Track your usage to avoid exceeding weekly limits.
Symptoms of ergotamine overdose/ergotism include severe limb pain, numbness, coldness, cyanosis, weak or absent pulses; chest pain or shortness of breath; confusion; severe GI distress; and potentially seizures. This is a life-threatening emergency.
If overdose is suspected: Call your local emergency number immediately. Do not drive yourself. Provide first responders with the medication name, dose taken, and timing. Medical teams may provide supportive care and vasodilators; do not attempt home remedies. Bring the medication bottle to the hospital if possible.
Store at room temperature as directed on your package insert (commonly 20–25°C/68–77°F), away from moisture, heat, and light. Keep tablets in the original container with the label intact. Do not store in bathrooms. Keep out of reach of children and pets. Safely discard expired tablets according to local guidance; do not flush unless labeling specifically instructs.
Reddit’s r/migraine and related communities often discuss ergotamine–caffeine combinations like Avamigran, especially in regions where it remains available. Common themes include:
- Early dosing matters: Users frequently report that taking the first tablet at aura or very early pain yields the best outcomes.
- Side effect trade-offs: Some describe nausea, cold extremities, or jitteriness that limit use, while others prefer Avamigran because triptans caused adverse effects or were contraindicated.
- Frequency control: Many emphasize strict adherence to maximum weekly limits to avoid rebound headaches.
- Access differences: Posters from outside the U.S. sometimes note easier access to ergotamine combinations; U.S.-based users more often discuss alternatives due to availability and prescribing restrictions.
To respect platform policies and user privacy, direct quotes and usernames are not reproduced here. For first-hand accounts, explore relevant threads on r/migraine and consult a clinician to interpret anecdotal reports in the context of your medical history.
WebMD hosts consumer reviews of many migraine medications, including ergotamine–caffeine combinations. Patient-reported themes often include:
- Effectiveness when timed right: Several reviewers note meaningful pain reduction if the first dose is taken promptly at onset.
- Variable tolerability: Commonly cited downsides are nausea, tingling, or cold hands/feet; some users switch to triptans or gepants due to side effects.
- Importance of guidance: Reviewers frequently mention that prescriber counseling on maximum usage and interactions helped them avoid complications.
Because WebMD content and user reviews change over time and vary by country/brand, verify details on WebMD directly and discuss any insights with your healthcare professional. To avoid misattribution and protect privacy, individual quotes and names are not reproduced here.
In the United States, ergotamine–caffeine migraine products are prescription medications. It is not legal or safe to buy Avamigran without prescription. Purchasing from non-verified or no-prescription sites risks counterfeit or substandard drugs, dangerous interactions, and legal issues. The appropriate pathway is a licensed clinician’s evaluation and a valid prescription filled at a state-licensed pharmacy.
Heritage Senior Center does not dispense medications and cannot provide Avamigran without a prescription. However, it can support patients by connecting them to legitimate, licensed care—including telehealth or in-person visits—where a qualified clinician can assess your migraines, screen for vascular risk, review interactions, and determine whether Avamigran or an alternative is appropriate. If prescribed, your medication should be dispensed by a licensed U.S. pharmacy or an accredited mail-order pharmacy.
Safe access checklist:
- Get a proper diagnosis (migraine with/without aura vs. another headache disorder).
- Share your full medication list, cardiovascular history, and pregnancy/breastfeeding status.
- Discuss rescue and preventive plans to minimize medication-overuse headache.
- Use only pharmacies verified by your state board of pharmacy or the National Association of Boards of Pharmacy (NABP). Look for programs like .pharmacy or state verification tools.
- Avoid any service offering Avamigran or ergotamine products “no prescription needed.” This is a red flag for illegal or counterfeit sources.
If Avamigran is not suitable or available, your clinician may suggest other evidence-based acute options (e.g., triptans, gepants, ditans, NSAID combinations, antiemetics) and a preventive regimen tailored to attack frequency and comorbidities. The goal is safe, effective relief while minimizing risks and avoiding rebound headaches.
Avamigran is an ergotamine-based combination medicine used for the acute treatment of migraine attacks. Ergotamine constricts dilated cranial blood vessels and modulates trigeminal neuropeptide release, while caffeine can enhance absorption and effectiveness. Some country-specific Avamigran formulations also include an antiemetic or analgesic; check your local patient leaflet for exact ingredients.
Avamigran is intended for acute migraine attacks, with or without aura. It is not a daily preventive medicine and is not typically used for tension-type headaches. Do not self-treat cluster headaches with Avamigran unless explicitly directed by a clinician.
Take it as early as possible at the first sign of a migraine attack or aura, following your local dosing instructions. Do not exceed the maximum dose per attack or per week stated on your product label, and avoid using it on more than a few days per week to reduce medication-overuse headache risk.
Onset is often within 30–60 minutes for oral tablets, with effects lasting several hours. If symptoms persist, some labels allow a repeat dose after a specified interval; always follow the exact directions on your package insert or your prescriber’s advice.
Do not use if you are pregnant or breastfeeding; have coronary artery disease, peripheral vascular disease, stroke/TIA, uncontrolled hypertension, severe liver or kidney disease, sepsis, or known hypersensitivity to ergot alkaloids. Avoid in hemiplegic or basilar-type migraine unless a specialist advises otherwise. Review your personal risk with a healthcare professional.
Nausea, vomiting, dizziness, drowsiness, flushing, tingling or numbness in fingers/toes, and cold extremities can occur. Seek urgent care for severe chest pain, shortness of breath, palpitations, severe limb pain or color change, or signs of decreased blood flow (possible ergotism).
Avoid combining with potent CYP3A4 inhibitors (for example clarithromycin, erythromycin, ketoconazole/itraconazole, ritonavir), other vasoconstrictors, nicotine/smoking, and triptans within 24 hours. Beta-blockers can increase vasospasm risk. Grapefruit juice may increase ergotamine levels. Always provide your clinician and pharmacist with a full medication list, including OTC and herbal products.
No. Ergot alkaloids can cause uterine contractions and reduced placental/breast blood flow. They are contraindicated in pregnancy and breastfeeding. Discuss safer migraine options with your obstetric provider.
Most formulations are approved for adults. Use in adolescents is generally not recommended unless a specialist advises. Older adults have higher cardiovascular risk and may be more sensitive to vasoconstrictive effects; careful medical evaluation is essential.
Using ergotamine-based medicines on more than 10 days per month can trigger medication-overuse headache. Many clinicians recommend keeping acute migraine treatments to two or fewer days per week on average. If you need them more often, ask about preventive therapies.
Do not exceed the recommended dose. Consider non-drug strategies (hydration, dark quiet room, sleep) and contact your clinician to discuss alternatives such as triptans, gepants, ditans, antiemetics, or preventive options. Reconfirm the migraine diagnosis if attacks are changing.
In many countries Avamigran or ergotamine-containing combinations are prescription-only. Availability varies widely by region, and some ergot products have been discontinued in certain markets. Ask your pharmacist about local regulations.
Avamigran can cause drowsiness, dizziness, or blurred vision. Do not drive or operate machinery until you know how it affects you and your migraine has improved.
Store at room temperature away from moisture, heat, and light. Keep in the original container and out of reach of children. Do not use after the expiration date; return expired or unwanted medicines to a pharmacy take-back program.
Generic ergotamine plus caffeine products exist in some markets, but brand names and exact combinations vary. Your pharmacist can advise on equivalent local options and formulation differences.
Some clinicians combine an ergotamine product with an NSAID or acetaminophen at the start of an attack if not already included in your formulation. Do not duplicate ingredients; check your label to avoid accidental overdose, particularly with acetaminophen.
Both are ergotamine plus caffeine combinations used for acute migraine. Depending on country, Avamigran may include additional components (such as an antiemetic or analgesic), while Cafergot traditionally contains only ergotamine and caffeine. Efficacy and class contraindications are similar; dosing schedules and maximums vary by label.
Migril in some regions combines ergotamine, caffeine, and cyclizine (an antiemetic/antihistamine). Avamigran may be compositionally similar in some markets or may differ. Products with cyclizine can reduce nausea but may increase drowsiness. Check your local product information to avoid taking duplicate antiemetics.
Vasograin (market-dependent) typically includes ergotamine, caffeine, paracetamol (acetaminophen), and prochlorperazine (an antiemetic). Avamigran’s exact makeup varies by country. If your migraines feature significant nausea, a built-in antiemetic may help; if not, a simpler ergotamine+caffeine product may suffice. Consider liver health and total daily acetaminophen exposure when comparing.
Yes. DHE is an ergot derivative available as nasal spray or injection, often used for severe or refractory attacks and status migrainosus. DHE tends to cause less arterial vasoconstriction than ergotamine but still carries vascular risks and similar contraindications. Avamigran is typically taken orally and is best early in an attack.
Sublingual ergotamine avoids some gastrointestinal absorption issues and may act faster than standard oral tablets, but it usually lacks caffeine, which can enhance absorption. Avamigran’s caffeine component may improve efficacy for some, while sublingual dosing suits those with gastric stasis during attacks.
Rectal Cafergot can be helpful when vomiting or severe nausea limits oral absorption. If your Avamigran is oral-only and nausea is prominent, a rectal ergotamine preparation or adding a separate antiemetic may provide better relief. Ask your clinician which route fits your pattern.
Both share class effects (vasoconstriction risk). DHE nasal can cause local irritation, altered taste, and nausea; Avamigran may cause caffeine-related restlessness and GI upset. Individual tolerance varies; cardiovascular contraindications apply to both.
Within the ergotamine+caffeine group, efficacy is broadly comparable when taken early in an attack at approved doses. Differences often come from formulation, absorption, added ingredients (antiemetic/analgesic), and personal response. Trial under medical guidance may be needed to find the best fit.
All ergotamine-containing medicines have strict maximums per attack, per day, and per week to reduce toxicity and ergotism risk. While many labels cap total ergotamine around 6 mg/day and 10 mg/week, you must follow your specific product’s limits and your prescriber’s instructions.
Cardiovascular safety is a class issue. Avamigran, Cafergot, Migril, and DHE are all contraindicated in significant vascular disease, uncontrolled hypertension, and with potent CYP3A4 inhibitors. Some clinicians prefer DHE over ergotamine in select settings, but the same high-level precautions apply.
Yes. If your Avamigran formulation does not include an antiemetic, doctors often add metoclopramide or domperidone to improve nausea and gastric emptying. Avoid duplicating antiemetics if your product already contains one, and review interaction risks.
Availability varies globally; some ergot products (including Cafergot) have been discontinued in certain countries, while Avamigran may be region-specific. Generics can reduce cost where available. Your pharmacist can advise on current local supply and equivalent options.