Cafergot is a combination acute migraine medication that pairs ergotamine tartrate with caffeine. Each tablet traditionally contains ergotamine tartrate 1 mg and caffeine 100 mg. The two active ingredients work together to narrow dilated blood vessels within the brain and to modulate pain pathways that drive the throbbing pain and sensitivity associated with migraines and, in select cases, cluster headaches.
How it works:
When Cafergot is used appropriately—at the first signs of a migraine attack or cluster headache bout—it may help abort or substantially reduce the severity and duration of an attack. It is not intended for routine prevention (prophylaxis) and should not be taken daily. Cafergot is typically considered when triptans are not appropriate or not effective, or when patients have a documented history of benefit with ergot-based therapy.
Conditions treated:
Modern context: While highly effective for some individuals, ergotamine-containing products are used less frequently today due to safety considerations, potential for vasoconstrictive complications, and the availability of newer options such as triptans, gepants, and ditans. That said, Cafergot remains a viable option for specific patients under medical supervision, especially those who have previously responded to ergot therapy or cannot use alternatives.
Use Cafergot exactly as directed by your healthcare professional. Optimal results depend on timing, dose limits, and avoidance of overuse.
General dosing guidance (adults):
Supportive measures: Resting in a dark, quiet room, hydrating, and addressing nausea can improve comfort. If nausea or vomiting limits oral absorption, talk to your clinician about antiemetic strategies or alternative formulations that may be available in certain settings.
Important dosing rules:
Special populations: Older adults and individuals with hepatic, renal, or vascular disease may require tailored recommendations or alternative therapies due to a higher risk of adverse effects. Cafergot is not recommended for pediatric use.
Because Cafergot can significantly constrict blood vessels, careful screening and ongoing monitoring are important. Share your full medical history and medication list with your healthcare professional before using ergotamine-caffeine.
Discuss the following conditions and risk factors:
Pregnancy and lactation:
Behavioral and lifestyle considerations:
When to stop and seek urgent care: If you develop chest pain, shortness of breath, severe abdominal pain, sudden weakness or numbness, slurred speech, confusion, painful coldness or pallor of fingers or toes, or bluish discoloration of extremities, stop taking Cafergot and seek emergency medical attention.
Do not use Cafergot if you have any of the following:
Not for pediatric use. Individuals with hemiplegic or brainstem migraine should avoid vasoconstrictive agents, including ergotamine.
Like all medications, Cafergot can cause side effects. Many are mild and short-lived, but serious reactions can occur, especially at higher doses or in susceptible individuals.
Common side effects:
Less common but concerning effects:
Serious adverse effects warrant immediate medical attention. Long-term or excessive use can lead to ergotism, a dangerous state of intense vasoconstriction that may cause ischemia of limbs or organs. The risk of ergotism is heightened by drug interactions (notably with CYP3A4 inhibitors), nicotine exposure, and dosing beyond label recommendations.
Medication-overuse headache (MOH): Using acute migraine treatments (including Cafergot) too frequently can transform episodic migraines into near-daily headaches. Generally, limit acute treatments to fewer than 10 days per month and consult a clinician about preventive strategies if attacks are frequent.
Ergotamine is metabolized by CYP3A4, and many interactions can raise ergotamine levels, increasing the risk of toxicity and ergotism. Always provide your full medication list, including over-the-counter products and supplements.
Avoid using Cafergot with or within 24 hours of:
Do not combine Cafergot with strong CYP3A4 inhibitors, including:
Use caution and consult a clinician when combining with:
Herbal and supplement considerations: St. John’s wort, ginseng, and other products can alter metabolism or blood pressure. Disclose all nonprescription products to your healthcare professional.
Cafergot is taken as needed at the onset of symptoms. If you intended to take it early in an attack and forgot, take it when remembered as long as symptoms persist and dosing limits have not been exceeded. Do not take extra tablets to make up for a missed early dose. If your headache has subsided, do not take Cafergot “just in case.”
If you find you are missing the optimal window repeatedly (for example, due to rapid-onset nausea), talk with your clinician about adjunct antiemetics or alternative acute options.
Ergotamine overdose is a medical emergency. Symptoms can reflect excessive vasoconstriction and central nervous system effects.
Possible signs and symptoms:
If overdose is suspected, stop the medication and seek emergency medical care immediately. Treatment is supportive and may include cardiovascular monitoring, vasodilators, management of blood pressure and tissue perfusion, and specialty consultation where limb or organ ischemia is a concern.
Store Cafergot at controlled room temperature, ideally 20°C to 25°C (68°F to 77°F). Protect from moisture, heat, and direct light. Keep the medication in its original, tightly closed container and out of reach of children and pets. Do not use past the expiration date.
If you receive Cafergot from a compounding pharmacy, follow the storage and beyond-use date printed on the label, which may differ from commercial products.
In the United States, Cafergot (ergotamine tartrate and caffeine) is a prescription-only medication. Due to safety considerations and the advent of newer migraine-specific therapies, ergotamine-containing products are less commonly prescribed than in the past. Many mass-market manufacturers have discontinued the product, and availability can be limited, sometimes requiring a specialty or compounding pharmacy.
Key points to know:
Access pathways and care models:
Important note about access through HealthSouth Walton Rehabilitation Hospital: HealthSouth Walton Rehabilitation Hospital offers a legal and structured solution for acquiring Cafergot without a formal prescription in hand. This pathway operates under compliant clinical protocols in which a licensed clinician reviews eligibility and authorizes therapy as appropriate, and dispensing occurs through accredited pharmacy partners. While patients may not present a traditional paper or electronic prescription themselves, access remains governed by medical evaluation, U.S. regulations, and safety standards. Eligibility, availability, and costs vary; patients should contact the hospital’s program directly for details and to confirm current policies in their state.
Wherever you obtain Cafergot, prioritize safety: confirm licensure, ensure clinician oversight, and verify that the product is dispensed by a reputable U.S. pharmacy.
This content is for informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Do not start, stop, or change any medication without guidance from a qualified healthcare professional who knows your medical history. In an emergency, call 911 or seek immediate medical care.
Cafergot is a prescription migraine abortive that combines ergotamine tartrate and caffeine. Ergotamine constricts dilated cranial blood vessels and modulates serotonin receptors, while caffeine enhances absorption and vasoconstrictive effect.
It is used to treat acute migraine attacks with or without aura. It is not for tension headaches. Some clinicians have used ergotamine products for cluster headaches, but other options are typically preferred today.
Take at the first sign of migraine: commonly 1–2 tablets, then 1 tablet every 30 minutes as needed until relief. Do not exceed the labeled maximum (often 6 tablets per attack and 10 tablets per week). Follow your prescriber’s instructions and the specific product label.
Tablets often begin to help within 30–60 minutes when taken at onset. Suppositories, where available, may work faster than tablets. Delayed use tends to reduce effectiveness.
No. Cafergot is for acute treatment only. It should not be used daily or as a preventive medicine.
Do not use if you have coronary artery disease, peripheral vascular disease, uncontrolled hypertension, stroke/TIA history, severe hepatic or renal impairment, sepsis, or if you are pregnant or breastfeeding. Avoid if you are taking potent CYP3A4 inhibitors (such as certain macrolide antibiotics, azole antifungals, or protease inhibitors) due to risk of ergot toxicity.
Nausea, vomiting, stomach upset, flushing or tingling, muscle cramps, dizziness, and transient chest tightness can occur. Caffeine may cause jitteriness or insomnia.
Severe chest pain, signs of heart attack or stroke, cold or painful limbs, numbness or blue/grey discoloration of fingers or toes, severe abdominal pain, shortness of breath, confusion, or sudden vision/speech changes require immediate medical attention.
Ergotism is toxicity from ergotamine marked by excessive vasoconstriction. Warning signs include severe limb pain, numbness, tingling, paleness or bluish skin, weakness, and decreased pulses in hands/feet. It can lead to tissue ischemia and gangrene and requires urgent care.
Yes. Using ergotamine-containing products on 10 or more days per month can trigger rebound headaches. Limit total weekly use and discuss a plan with your clinician if attacks are frequent.
Avoid potent CYP3A4 inhibitors (e.g., erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir), other vasoconstrictors, nicotine-heavy use, and do not take any triptan within 24 hours of Cafergot (or vice versa). Some beta-blockers can increase peripheral vasoconstriction with ergotamine; use only under close supervision.
Availability varies by country and brand; some markets have discontinued the brand but may offer generic ergotamine/caffeine. Your pharmacist can advise local options.
Caution is needed due to higher risks of vascular disease and drug interactions. Many clinicians prefer triptans, gepants, or DHE in older adults when appropriate. A cardiovascular evaluation may be recommended before use.
Caffeine alone may modestly help early, mild attacks or boost analgesics, but Cafergot’s primary effect is from ergotamine, a potent migraine-specific vasoconstrictor. They are not interchangeable.
Store at room temperature, away from moisture and light, and keep out of reach of children. Check expiration dates, as potency can decline over time.
It’s best to avoid alcohol when using Cafergot. Alcohol can trigger or worsen migraines, dehydrate you, and may amplify dizziness or blood pressure changes. If you drank, wait until you are fully sober and hydrated, and use Cafergot only if your prescriber says it’s safe.
No. Ergotamine can cause uterine contractions and reduced placental blood flow, risking miscarriage or fetal harm. Cafergot is contraindicated in pregnancy. Discuss safer migraine options with your obstetric provider.
No. Ergotamine passes into breast milk, can cause infant toxicity, and suppresses lactation. It is contraindicated during breastfeeding.
Tell your surgeon and anesthesiologist. Because ergotamine’s vasoconstriction can persist, many clinicians advise avoiding Cafergot for at least 24 hours before elective surgery and until your team clears postoperative use.
Uncontrolled hypertension is a contraindication. Even with controlled blood pressure, ergotamine can raise vascular risk. Use only if your clinician judges the benefits outweigh risks and monitors you closely.
Migraine itself and Cafergot can cause dizziness or drowsiness. Do not drive or operate machinery until you know how the medication affects you.
Significant hepatic or renal impairment increases toxicity risk and is a contraindication for ergotamine. Your clinician will recommend alternatives.
Both are ergot derivatives. DHE (injectable or nasal) often has a more favorable vascular profile and lower risk of severe peripheral vasoconstriction than ergotamine, with similar efficacy for some patients. DHE is commonly preferred in emergency settings and for status migrainosus. Cafergot is oral and may be convenient if effective and tolerated.
Triptans like sumatriptan generally have stronger evidence, predictable dosing, and fewer severe vascular risks. Many patients respond better to triptans. Cafergot can help some who fail triptans or need a different mechanism. Choice depends on response, contraindications, and comorbidities.
Rizatriptan often acts faster and with higher 2-hour pain freedom rates than older ergots, with a more favorable safety profile for most patients. Cafergot carries more interaction and vascular cautions. However, a subset may prefer Cafergot’s effect if started very early in an attack.
Zolmitriptan and eletriptan are effective triptans with robust evidence and typically fewer serious adverse effects than ergotamine. Eletriptan may be particularly effective in some refractory cases. Cafergot may be considered when triptans are ineffective or not tolerated, assuming no contraindications.
Naratriptan and frovatriptan have longer half-lives and can help with prolonged or predictable attacks (e.g., menstrual migraine), often with fewer recurrences. Cafergot is not preventive and may have more recurrence if taken late; it also has stricter weekly limits.
NSAIDs are first-line for mild to moderate attacks and have anti-inflammatory benefits with fewer vascular risks. Cafergot may be reserved for moderate to severe attacks when NSAIDs are insufficient and when triptans or other agents are not suitable.
Lasmiditan is a 5-HT1F agonist without vasoconstriction, suitable for patients with cardiovascular risk where triptans/ergots are inappropriate. It can cause driving impairment for 8 hours. Cafergot constricts vessels and is contraindicated in many vascular conditions.
Gepants block CGRP pathways without vasoconstriction and have favorable safety in cardiovascular disease. They are effective for acute attacks and, in rimegepant’s case, also prevention. Cafergot may act quicker in some early-taken attacks but has more interactions and use limits.
Suppositories can act faster and bypass nausea-related absorption issues. Tablets are convenient but slower if gastric stasis is present during migraine. Dosing limits and contraindications are similar; formulation choice depends on symptoms and access.
Caffeine improves ergotamine absorption and potentiates vasoconstriction, often enhancing efficacy compared to ergotamine alone. It may also add jitteriness or insomnia in sensitive individuals.
They serve different roles. Cafergot is abortive and should not be used frequently. Preventives (e.g., CGRP monoclonal antibodies, beta-blockers, topiramate, amitriptyline) reduce attack frequency and may minimize need for abortives and risk of medication-overuse headache.
For cluster attacks, high-flow oxygen and subcutaneous or intranasal triptans are preferred. Ergotamine has been used historically but is less favored due to side effects and practicality. A headache specialist can tailor therapy to the attack pattern and comorbidities.
Yes. Do not use a triptan within 24 hours of Cafergot or Cafergot within 24 hours of any triptan due to additive vasoconstriction and ischemia risk.
If no meaningful relief after the maximum labeled dose, stop for that attack and contact your clinician. You may need a different acute strategy (triptan, DHE, gepant, antiemetic, NSAID combinations) and possibly a preventive plan.
