Common use of Cafergot (ergotamine-caffeine) for migraines
Cafergot is an acute migraine treatment—intended to stop an attack that has already started. Its two active components work together: ergotamine tartrate constricts dilated intracranial blood vessels and inhibits the release of inflammatory neuropeptides, while caffeine enhances ergotamine absorption and adds mild vasoconstrictive and analgesic-sparing effects. This combination can reduce pulsating head pain, photophobia, phonophobia, and nausea in appropriately selected patients.
Cafergot is typically used for migraine with or without aura and, in some cases, for cluster headaches under specialist guidance. It is not a daily preventive (prophylactic) medication and should not be used to reduce the frequency of attacks. Instead, it is taken at the earliest warning signs—often during aura or mild pain—to maximize efficacy and minimize the total amount needed.
Because ergot derivatives can constrict blood vessels throughout the body, Cafergot is not suitable for everyone. It is reserved for adults without significant cardiovascular disease or uncontrolled hypertension, and for those who do not respond well to, or cannot take, other first-line acute migraine therapies like triptans or NSAIDs. Using Cafergot more than the recommended limits increases the risk of medication-overuse headache and rare but serious ischemic complications.
Cafergot dosage and direction
Follow your prescriber’s instructions exactly. A commonly used regimen for Cafergot tablets (ergotamine tartrate 1 mg/caffeine 100 mg) is: take 1–2 tablets at the first sign of a migraine. If needed, 1 additional tablet may be taken every 30 minutes until relief, not to exceed 6 tablets per attack and no more than 10 tablets in any 7-day period. Do not use Cafergot for more than 2 days per week on a regular basis to avoid medication-overuse headaches.
Swallow tablets with water. Taking Cafergot at onset increases the chance of aborting the attack. If nausea is prominent, your clinician may recommend an antiemetic 10–15 minutes beforehand to improve tolerance and absorption. Avoid grapefruit products, which can raise ergotamine levels via CYP3A4 inhibition and increase the risk of toxicity.
Never take Cafergot within 24 hours of a triptan (such as sumatriptan, rizatriptan, zolmitriptan) or another ergot-containing medicine. Likewise, do not take a triptan within 24 hours of Cafergot. Combining vasoconstrictors can provoke dangerous blood vessel spasm and ischemia. If your symptoms are not improving despite the maximum recommended dose, seek medical advice rather than taking more.
Cafergot precautions: who should use it and how to stay safe
Before starting Cafergot, your clinician should evaluate cardiovascular risk factors such as age, smoking status, blood pressure, lipid profile, family history of early heart disease, and any history of Raynaud’s phenomenon or peripheral vascular disease. In higher-risk individuals, additional cardiac evaluation may be recommended before prescribing a vasoconstrictive agent.
Use Cafergot strictly within the prescribed limits. Overuse may lead to medication-overuse headache (rebound), diminishing benefit and amplifying side effects. Smoking or using nicotine products increases the risk of peripheral vasoconstriction and should be avoided. Caffeine in Cafergot can contribute to jitteriness, palpitations, or insomnia; account for all dietary caffeine to reduce overstimulation.
Pregnancy, attempting conception, or breastfeeding require special caution. Ergotamine is contraindicated during pregnancy and postpartum because it can reduce uterine blood flow and milk production. Discuss all medications and supplements you take, especially those affecting liver enzymes (CYP3A4), with your healthcare professional to minimize interaction risks. If you develop chest pain, severe limb pain, coldness or color change in fingers or toes, new numbness/weakness, or severe abdominal pain after taking Cafergot, seek urgent care.
Cafergot contraindications
Do not use Cafergot if you have: coronary artery disease, history of myocardial infarction, stroke or TIA, peripheral vascular disease, uncontrolled hypertension, severe hepatic or renal impairment, sepsis, or known hypersensitivity to ergot alkaloids. It is also contraindicated in pregnancy and during breastfeeding, and should not be used for hemiplegic or basilar-type migraine.
Avoid Cafergot if you are taking potent CYP3A4 inhibitors (e.g., clarithromycin, erythromycin, ketoconazole, itraconazole, voriconazole, cobicistat, ritonavir, nelfinavir, indinavir) because these can dramatically increase ergotamine blood levels and precipitate life-threatening vasospasm and ischemia. Do not take Cafergot within 24 hours of a triptan or any other ergot-containing medication.
Possible Cafergot side effects
Common side effects include nausea, vomiting, abdominal discomfort, flushing, dizziness, and fatigue. Because the caffeine component can be stimulating, some people experience jitteriness, tremor, palpitations, anxiety, or insomnia, especially if other caffeine sources are consumed.
Vasoconstrictive effects may cause tingling, numbness, coldness, or pain in fingers and toes; muscle cramps; and, rarely, chest pressure. If you notice blue or pale discoloration of extremities, severe limb pain, reduced pulses, or chest pain, stop the medication and seek immediate medical care—these can be signs of significant ischemia (ergotism).
Less commonly, ergotamine has been associated with fibrosis (e.g., pleural, retroperitoneal) after prolonged, excessive use. This is one reason Cafergot should only be used intermittently and within limits. Any new shortness of breath, persistent cough, back or abdominal pain, or urinary changes after chronic ergot exposure warrants prompt evaluation.
Cafergot drug interactions
Serious interactions occur with strong CYP3A4 inhibitors, which can cause dangerously high ergotamine levels. Avoid combining Cafergot with macrolide antibiotics (clarithromycin, erythromycin, telithromycin), azole antifungals (ketoconazole, itraconazole, voriconazole, posaconazole), HIV protease inhibitors (ritonavir, nelfinavir, indinavir), cobicistat-boosted regimens, and grapefruit or Seville orange products. Always inform your clinician and pharmacist about all prescriptions, OTC medicines, and supplements.
Do not use Cafergot within 24 hours of any triptan (sumatriptan, rizatriptan, zolmitriptan, eletriptan, almotriptan, frovatriptan, naratriptan) or other ergot derivatives (dihydroergotamine, methylergonovine) because additive vasoconstriction can cause ischemia. Combining Cafergot with nicotine, vasoconstrictive decongestants (e.g., pseudoephedrine), or certain beta-blockers may increase peripheral vasospasm risk; ask your clinician about safe combinations.
The caffeine component can interact with drugs that affect caffeine metabolism. Fluoroquinolone antibiotics (e.g., ciprofloxacin, enoxacin) may raise caffeine levels, potentially increasing tremor, restlessness, or palpitations. Consider reducing other caffeine sources when taking Cafergot. Sedatives may counteract caffeine’s alerting effects without reducing ergot-related risks—avoid self-adjusting medications and seek professional guidance.
Missed dose
Cafergot is not taken on a fixed schedule. If you do not take it at the onset of an attack, you can still use it as directed during that episode, staying within per-attack and weekly maximums. Do not “make up” for a missed opportunity by exceeding dose limits later in the day or week.
If attacks are frequent enough that you’re tempted to use Cafergot several days per week, talk with your clinician about preventive options and alternative acute therapies to reduce overall exposure and the risk of medication-overuse headache.
Overdose
Ergotamine overdose can lead to severe vasospasm (ergotism), presenting with intense limb pain, paresthesias, pallor or cyanosis of fingers/toes, diminished pulses, chest pain, abdominal pain, persistent vomiting, confusion, or seizures. This is a medical emergency. Call your local emergency number or poison control right away. Do not take additional vasoconstrictive medications.
Management typically involves supportive care, control of nausea, careful cardiovascular monitoring, and medications to reverse vasospasm where appropriate. If a large ingestion occurred recently, clinicians may consider activated charcoal. Early medical evaluation improves outcomes—bring the medication bottle or a list of doses taken if possible.
Storage
Store Cafergot at controlled room temperature (generally 20–25°C/68–77°F), protected from excessive heat, light, and moisture. Keep tablets in a tightly closed container and out of reach of children and pets. Do not use medications past their expiration date, and dispose of them per pharmacy guidance or local take-back programs.
If you carry Cafergot for on-the-go use, avoid leaving it in hot cars or humid bathrooms, which can degrade potency. Check the appearance of tablets periodically and replace if compromised.
U.S. sale and prescription policy: can you buy Cafergot without prescription?
In the United States, Cafergot (ergotamine-caffeine) is a prescription-only medication. There is no legal pathway to buy Cafergot without prescription. Any website or vendor offering ergotamine products “no Rx needed” is a red flag for counterfeit, unsafe, or illegally imported drugs. For your safety and to stay compliant with U.S. law, obtain Cafergot only after evaluation by a licensed clinician and fill it through a verified pharmacy.
If you’re seeking convenient access, reputable health systems and telemedicine services can provide a structured clinical assessment and, when appropriate, an electronic prescription to your pharmacy. Large integrated systems (for example, Geisinger and other reputable providers) offer legitimate care pathways—but they do not bypass the requirement for a prescription. Avoid unverified online sellers; look for pharmacies accredited by the National Association of Boards of Pharmacy (e.g., .pharmacy domains) or recognized by LegitScript.
If Cafergot is not right for you or is unavailable, your clinician may recommend alternatives such as triptans, gepants (ubrogepant, rimegepant), ditans (lasmiditan), or NSAIDs, tailored to your medical history. Discuss insurance coverage and generic options to minimize cost. Bottom line: do not attempt to buy Cafergot without prescription—use a legal, clinician-guided process to ensure the medication is safe and appropriate for your migraines.
