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The Link Between Migraine Nausea and Vomiting
Why do migraines so often include nausea? And what can you do about it? By Becky UphamMedically Reviewed by Jason Paul Chua, MD, PhDReviewed: June 17, 2021Medically ReviewedEffective migraine treatment can reduce the nausea that often accompanies an attack.If you often feel queasy or lose your appetite as you feel a migraine attack coming on, it may (or may not) give you some comfort to know that you’re in good company. A telephone survey of 500 people published in Headache journal found that a whopping 90 percent of people with migraine reported experiencing nausea, and nearly one-third of those people experienced it with every attack. Almost 70 percent of people had vomiting as part of their migraine attack, with one in three vomiting during nearly every attack. What’s behind the connection between a throbbing headache and a churning stomach, and more importantly, is there anything you can do to stop nausea or vomiting when it comes with migraine? Here are some answers to your questions about migraine, nausea, and vomiting. 1 Is Nausea a Side Effect of Migraine
Nausea is a common symptom of migraine — so common that it’s part of the diagnostic criteria, according to Roderick Spears, MD, a neurologist and headache specialist at Penn Medicine in Philadelphia. Nausea doesn’t look the same for everyone with migraine, however, says Dr. Spears. “In some people, if they have mild nausea, it might present as what we call anorexia, where you just don’t have an appetite; you don’t want to eat because you feel like you will get sick,” he says. “For more full-blown nausea, the person may be sweating, and if they don’t stop the migraine, they’re going to start vomiting,” says Spears. 2 Is Nausea or Vomiting More Common With Any Specific Type of Migraine
Nausea and vomiting can occur with migraine with and without aura. These symptoms are often found in vestibular migraine, a type of migraine that may or may not come with head pain. Symptoms of vestibular migraine can include vertigo and loss of balance, according to Johns Hopkins Medicine. People with vestibular migraine usually experience motion sickness (car or seasickness) beginning in childhood and have a history of migraine headaches. 3 Why Do You Get Nauseated During a Migraine Attack
Nausea often occurs during the prodrome phase in migraine, according to the American Migraine Foundation, but it can occur in any phase of the attack. The prodrome signals the beginning of a migraine attack and can last hours or as long as several days. “We don’t know exactly why some people experience nausea with migraine, though the common denominator seems to be [the hormone] serotonin. Serotonin plays a role in the brain during a migraine attack, and there are a lot of serotonin receptors in the gut,” explains Spears. It had been previously thought that gastric stasis, which is when the stomach empties more slowly than normal, was the underlying cause of nausea in migraine. More recent research has shown that improving gastric stasis during a migraine attack still doesn’t relieve nausea, according to a paper published in Patient Related Outcome Measures. 4 Does Throwing Up Help Relieve a Migraine Attack
“There are some migraine patients, especially younger patients, who know that if they vomit during a migraine attack it will actually abort the attack. There may be different explanations for why this is the case, but we know that vomiting will release intracranial pressure,” says Spears. Although vomiting may help stop your migraine attack, it’s not recommended that you try to make yourself throw up, adds Spears. “The goal is to help patients avoid throwing up when that’s possible,” he says. If you do vomit, it’s recommended that you drink water afterward to avoid dehydration, according to MedlinePlus. And if you develop uncontrollable vomiting, you should seek immediate medical attention, according to Cedars Sinai health system. 5 How Do You Get Rid of Nausea Caused by Migraine
If you experience nausea as a symptom of migraine, talk to your doctor to make sure it’s addressed in your treatment plan. “Almost all new migraine therapies treat what is called the ‘most bothersome symptoms,’ which include light sensitivity and sound sensitivity, along with nausea and vomiting,” says Spears. Triptans, for example, if taken early in a migraine attack, can stop the attack and alleviate the symptoms, including nausea, according to the National Headache Foundation. On the other hand, some people experience nausea as a side effect of triptans. Ditans and gepants are newer abortive migraine medications that target very specific receptors on sensory nerves. These drugs are also designed to treat nausea and vomiting as part of stopping a migraine attack. 6 Can Eating Certain Foods or Skipping Meals Trigger Nausea or Migraine
Certain foods, and skipping meals, can trigger a migraine attack, and nausea can be a symptom that occurs during the attack, says Spears. “It’s not as common for people to do something to cause nausea and then end up with a migraine attack on the back end; it’s only in a small percentage of patients that nausea would occur first,” he says. When it comes to which foods trigger a migraine, it varies from person to person, says Lauren Doyle Strauss, DO, a headache specialist and assistant professor at Wake Forest Baptist Health in Winston-Salem, North Carolina. “Moderation is a good idea — don’t eat or drink anything to excess. Avoid things with a lot of preservatives in them, such as processed meats or hard cheeses,” she says. Because skipping meals can trigger migraine attacks, it’s a good idea for people with headaches or migraine to routinely have breakfast, lunch, and dinner with some snacks throughout the day, according to Dr. Strauss. This can help maintain blood sugar levels and prevent hypoglycemia, which is when blood sugar drops to a low level, and may bring on a headache or make it worse, according to the National Headache Foundation. RELATED: 12 Foods to Help Get Rid of a Headache or Migraine Attack Naturally 7 Can Nausea Reduce the Effectiveness of Acute Migraine Treatments Taken Orally
In some cases, yes, says Spears. “I find this is especially true for nocturnal migraines — the migraines that wake people from sleep. Often, the nausea is so far down the road at that point that taking an oral medication can be ineffective, so those individuals do need an alternative route of administration,” he says. Alternatives to pills you have to swallow with water could be an oral dissolvable, a nasal spray, or an injectable, says Spears. “It could also be a rectal suppository, which aren’t very popular anymore but are a viable option,” he adds. If you have nausea, taking your medication a different way may improve its efficacy, according to Simona Sacco, MD, a full professor of neurology at the University of L’Aquila in Italy and the director of the clinical unit of neurology and the stroke unit at the Avezzano Hospital, in a presentation she gave at the sixth annual Migraine World Summit, held March 17 to 25, 2021. Early nausea can be an indication that there’s some impairment in how the gut is working, Dr. Sacco said. “This may lead to delay or incomplete absorption of an oral drug. If this is suspected, it’s better to use nonoral drugs.” NEWSLETTERS Sign up for our Chronic Pain Newsletter
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