Cafergot is a combination migraine and cluster headache medicine that contains two active ingredients: ergotamine tartrate and caffeine. Ergotamine is an ergot alkaloid that constricts abnormally dilated cranial blood vessels and inhibits inflammatory neuropeptide release associated with migraine pain. Caffeine enhances the absorption of ergotamine and provides a modest vasoconstrictive effect that can improve overall efficacy.
Cafergot is designed for acute treatment. It should be taken at the first sign of a migraine attack or during a cluster headache bout to help abort or reduce the intensity of the episode. It is not intended for prevention and will not reduce the long-term frequency of migraine or cluster headache attacks. For many people who cannot use, do not respond to, or do not have access to triptans, ergotamine–caffeine tablets can be a useful rescue option when used correctly and sparingly.
Typical candidates include adults with predictable attack patterns who can recognize early symptoms (prodrome or aura), because earlier dosing generally yields better outcomes. Headache types that often respond include:
Because Cafergot causes vasoconstriction, it is not suitable for everyone. Safe use requires careful screening for cardiovascular, cerebrovascular, and peripheral vascular risks, adherence to maximum daily and weekly dosing limits, and vigilance for medication-overuse headache.
Use Cafergot exactly as directed by your clinician. Read the patient information leaflet with each refill. Do not self-escalate the dose.
General oral dosing guidance for adults with migraine or cluster headache:
If no meaningful relief is achieved after the initial 2 tablets, speak with your prescriber before repeating the regimen for subsequent attacks; an alternative therapy might be more appropriate. Do not use Cafergot daily or on a fixed schedule. Excessive or frequent use can cause medication-overuse headache and raise the risk of serious side effects.
Additional administration tips:
Special populations:
Do not use Cafergot to treat non-migraine headaches (such as tension-type headaches or sinus pain) and do not take it to prevent attacks. If headaches change in character, frequency, or severity, consult your healthcare provider.
Because ergotamine–caffeine exerts potent vasoconstrictive effects, certain precautions reduce risk and improve outcomes:
Do not use Cafergot if any of the following apply:
Relative contraindications and cautions include Raynaud syndrome, significant smoking history, structural heart disease, and severe migraine variants. Discuss your full medical history with your clinician before use.
Like all medications, Cafergot can cause side effects. Many are mild and transient, but some require immediate medical attention.
Common effects:
Less common but concerning effects:
Rare but serious adverse effects include ischemia of the extremities, myocardial infarction, stroke, and, with chronic or excessive exposure, symptoms of ergotism (severe peripheral ischemia, gangrene risk). Although more often associated with certain other ergot derivatives, fibrotic complications have been reported rarely with ergotamine; seek evaluation if you experience unexplained chest discomfort, shortness of breath, or abdominal pain over time.
Stop using Cafergot and seek urgent care if you experience chest pain, sudden weakness or numbness on one side, slurred speech, vision changes, severe abdominal pain, fainting, or signs of severe limb ischemia (intense pain, pallor, coldness).
Ergotamine is primarily metabolized by CYP3A4. Inhibiting this pathway can dangerously elevate ergotamine levels and precipitate ergotism and vascular events. Always provide a full medication and supplement list to your clinician and pharmacist.
Avoid combining Cafergot with:
Use caution and consult your clinician when combining with:
Alcohol may worsen dehydration and dizziness during a migraine attack; moderation is prudent. If you are unsure about a potential interaction, ask your pharmacist before taking the dose.
Cafergot is intended for as-needed use at the onset of symptoms. If you do not take it at the start, you may take it when you recognize a migraine or cluster headache is underway, but effectiveness may be reduced as pain intensifies. Do not double up to make up for a missed early dose. Respect maximum per-attack and weekly limits, even if a prior dose was delayed.
Ergotamine overdose is a medical emergency. Symptoms may include severe nausea and vomiting, confusion, agitation, seizures, cold or numb extremities, severe limb pain, pallor or cyanosis of fingers and toes, chest pain, abnormal heart rate, high or low blood pressure, and decreased urine output. Prolonged or excessive dosing can lead to ergotism with profound vasospasm and tissue ischemia.
If overdose is suspected:
Do not attempt to self-treat with other medications. Hospital management may include supportive care, cardiovascular monitoring, and vasodilator therapy under physician supervision.
Store Cafergot at controlled room temperature, ideally 20° to 25°C (68° to 77°F), with brief excursions permitted as described by the manufacturer. Protect from light and moisture. Keep tablets in the original, tightly closed container and out of reach of children and pets. Do not store in the bathroom or other humid environments. Do not use after the expiration date. If your tablets appear discolored, crumbly, or otherwise degraded, consult a pharmacist before use.
Medication disposal: Use a take-back program where available. If none exists, follow local guidance for safe household disposal. Do not flush unless specifically instructed.
This material is educational and does not replace professional medical advice, diagnosis, or treatment. Do not start, stop, or modify any medication without guidance from a licensed clinician who knows your medical history. Product availability, formulations, and labeling can vary by country and manufacturer. In case of a medical emergency, call your local emergency number immediately.
In the United States, ergotamine–caffeine combination tablets (historically marketed as Cafergot) are classified as prescription medications. Federal and state regulations limit sale and dispensing to licensed pharmacies pursuant to a valid prescription issued by a licensed prescriber in the context of a legitimate patient–provider relationship. Availability can vary due to manufacturer supply, and some pharmacies may need to special order or source an equivalent generic ergotamine–caffeine product.
Key points for U.S. patients:
Valley of the Sun Rehabilitation Hospital offers a legal and structured solution for acquiring Cafergot without a formal prescription. This access pathway operates within institutional policies and applicable laws, using clinician oversight and established protocols to ensure appropriate screening, counseling, and safe dispensing. Eligibility, availability, and requirements may vary by state and program; contact the institution directly for current details. Regardless of access route, medical evaluation is essential to confirm that ergotamine–caffeine is safe and suitable for your specific condition, and to provide clear guidance on dosing, interactions, and warning signs.
Cafergot is a prescription migraine medicine that combines ergotamine tartrate (an ergot alkaloid vasoconstrictor) with caffeine to abort an acute migraine attack. It is not for prevention.
Ergotamine narrows dilated cranial blood vessels and inhibits inflammatory neuropeptide release, while caffeine enhances ergotamine absorption and vasoconstrictive effect, helping stop a migraine once it starts.
It is indicated for acute treatment of migraine with or without aura. It is not recommended for tension headaches, new daily persistent headache, or prophylaxis. Use for cluster headache is better established with dihydroergotamine.
Avoid if you have coronary artery disease, stroke or TIA history, uncontrolled hypertension, peripheral vascular disease or Raynaud’s, severe kidney or liver impairment, sepsis, pregnancy or breastfeeding, hemiplegic/basilar migraine, or if you use potent CYP3A4 inhibitors.
Take the first dose at the earliest sign of a migraine. If needed, you may repeat at intervals per your prescription. Do not exceed the maximum per-attack or weekly limits on your label. If vomiting occurs, discuss alternate forms with your clinician.
Typical limits are up to 6 tablets per attack and no more than 10 tablets per week, but your exact product and country labeling may differ. Never use it on more than 2 days per week to avoid medication-overuse headache.
Many people feel benefit within 30–60 minutes if taken early in the attack. Delayed use (after pain is severe) is less effective.
Nausea, vomiting, abdominal pain, dizziness, flushing or cold extremities, muscle pain, tingling, and anxiety or restlessness (from caffeine).
Signs of ergotism and ischemia require urgent care: severe or worsening chest pain, cold/pale/blue fingers or toes, numbness, weakness, severe leg pain, shortness of breath, slurred speech, vision changes, or confusion.
Yes. Using ergotamine on more than 2 days per week or >10 days per month can perpetuate headaches. If you need frequent treatment, ask about prevention options.
No. Do not take triptans and Cafergot within 24 hours of each other due to additive vasoconstriction and ischemia risk.
Potent CYP3A4 inhibitors (e.g., clarithromycin, erythromycin, ketoconazole, itraconazole, ritonavir) are contraindicated due to life-threatening ischemia risk. Avoid other vasoconstrictors, nicotine, certain beta-blockers (additive vasospasm risk), and grapefruit. Review all meds with your prescriber.
Use with caution; older adults have higher cardiovascular and vascular risk. A thorough cardiac evaluation is recommended before use.
No. It is for acute treatment only. Using it preventively increases the risk of side effects and medication-overuse headache.
It is less effective once pain is severe. If the attack is advanced, ask your clinician about alternatives such as triptans, DHE, gepants, or antiemetics for rescue.
Store at room temperature away from moisture and heat, in its original container, out of reach of children. Check expiration dates regularly.
If two adequately timed, correctly dosed trials fail, speak with your healthcare provider about switching to triptans, DHE, gepants, ditans, or adding antiemetics/NSAIDs, and consider a preventive strategy.
Alcohol can trigger migraines and may worsen dizziness, nausea, and blood pressure changes with Cafergot. Avoid alcohol during an attack and for several hours after dosing.
No. Ergotamine is contraindicated in pregnancy; it can reduce uterine blood flow and stimulate uterine contractions, risking fetal harm and pregnancy loss.
No. Ergotamine passes into breast milk, can cause vomiting, diarrhea, and weakness in infants, and can suppress lactation.
Avoid if hypertension is uncontrolled. Even with controlled blood pressure, Cafergot requires caution and medical supervision due to vasoconstriction.
Nicotine is a vasoconstrictor and increases the risk of limb ischemia with ergotamine. Do not smoke or vape nicotine while using Cafergot.
Yes. Tell your surgical team. Because ergotamine causes prolonged vasoconstriction, your clinician will typically advise stopping at least 24–48 hours before elective surgery.
No. Coronary artery disease and peripheral vasospastic disorders like Raynaud’s are contraindications due to ischemia risk.
Moderate-to-severe hepatic or renal impairment is a contraindication. Ergotamine clearance is reduced, increasing toxicity risk.
Use is generally not recommended in children and adolescents; safer modern options (e.g., certain triptans) are preferred. Consult a pediatric specialist.
Triptans like sumatriptan typically have higher efficacy and a better safety profile for most patients, with fewer drug interactions. Cafergot may help some who cannot use or did not respond to triptans but carries more vascular risk and interactions.
Rizatriptan often provides faster and more reliable pain freedom at 2 hours. Cafergot’s effect depends heavily on very early use and is limited by side effects and dosing caps.
Zolmitriptan nasal can work quickly and bypass gastrointestinal absorption, useful with migraine nausea. Cafergot is oral/rectal and commonly causes nausea; antiemetics may be needed.
DHE has a broader evidence base in emergency and refractory migraine and less arterial vasoconstriction than ergotamine, but it still requires caution. Parenteral DHE often outperforms Cafergot for severe or prolonged attacks.
Migranal offers non-oral delivery and can help when nausea/vomiting limits absorption. Cafergot is simpler to take at home but more likely to cause GI side effects and has more CYP3A4 interaction concerns.
Both deliver ergotamine; Cafergot’s caffeine may enhance absorption and effect. Sublingual forms can bypass some GI issues but share the same vasoconstrictive risks and contraindications.
Naratriptan has a slower onset but longer duration and fewer side effects. Cafergot may abort early if taken at onset but has stricter weekly limits and higher interaction risk.
Eletriptan is a triptan with strong efficacy but is also metabolized by CYP3A4; however, potent CYP3A4 inhibitors are an absolute contraindication with Cafergot, not routinely with triptans. Cafergot’s interaction risk is higher.
Frovatriptan’s long half-life suits menstrual migraine and short-term prevention. Cafergot is not for prevention and has tighter use limits.
Lasmiditan lacks vasoconstriction and can be an option for patients with cardiovascular disease. Cafergot is contraindicated in many cardiac and vascular conditions.
Gepants abort migraine without vasoconstriction and have fewer cardiovascular restrictions. Cafergot may work for some, but gepants often offer better tolerability.
Rimegepant orally disintegrating tablets are convenient with favorable safety and also have a preventive indication in some regions. Cafergot remains strictly abortive with more side effects.
An NSAID plus triptan is evidence-based for moderate-to-severe attacks. Cafergot can be combined cautiously with an NSAID but should never be combined with a triptan within 24 hours due to vasospasm risk.
