Migraine and Nausea

The Problematic Combination

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When you suffer from a migraine, do you also experience that queasy and unsettling pit-in-your-gut sensation known as nausea? Nausea can occur within a scope of many medical conditions including infections, gastrointestinal ailments and brain disorders. Migraines, nevertheless, are an all too common culprit of nausea. Let’s explore this problematic combination of headaches and nausea in more detail.

A Problematic Combination

The experience of nausea for migraineurs is an all too familiar and burdensome one. There are two main problems that occur as a result of nausea accompanying head pain:

  • Nausea often worsens an already debilitating migraine attack.
  • Nausea makes abortive treatment of migraines more difficult.

How Common is Nausea During a Migraine Attack?

In one study in Headache, of nearly 6500 individuals who suffered from episodic migraines, half experienced high-frequency nausea, defined as nausea occurring ≥ half the time with a headache. Nearly thirty percent reported experiencing nausea less than half the time with their migraines, and a little over twenty percent reported never or rarely experiencing nausea. The study also found that high-frequency nausea was more common in women than men.

Problem #1: Nausea Worsens the Migraine Attack

The above study in Headache also found that the individuals who experienced high-frequency nausea with their headaches were more likely to experience other more significant migraine symptoms such as: photophobia, phonophobia, severe head pain and pain worsened by routine activities.

Additionally, when comparing individuals with high-frequency nausea versus no or rare occurrence of nausea with head pain, those with nausea were more likely to be on medical leave from their jobs or be on employment disability.

Finally, in this same study, the migraineurs were given the Headache Impact Test (HIT-6), a six-question tool or test used to determine the impact of one’s headache on daily functioning.

For example, one test question is “In the past 4 weeks, how often have you felt too tired to do work or daily activities because of your headaches?” The participants then answer either: “never, rarely, sometimes, very often, or always.” Results showed that close to half of those with high-frequency nausea scored in the highest very severe HIT-6 impact category.

Problem #2: Nausea Hinders Treatment

Another problem of suffering from both headache and nausea is that patients are often reluctant to take their migraine medication. In fact, in a National Headache Survey in 2010, 4 out of 10 migraineurs in the United States noted that they delayed or avoided taking medication due to migraine-related nausea and/or vomiting. Delaying or avoiding migraine medication can only prolong the migraine attack, worsening one’s functioning and overall quality of life. Furthermore, vomiting or nausea, itself, can inhibit medication absorption, rendering migraine therapy ineffective.

What is the Solution? Treatment Options for Headache AND Nausea

The good news is that there are lots of options out there to treat your head pain, while taking into account your migraine-related nausea. Triptans are migraine therapies available in multiple formulations, that can be used as first-line treatments for moderate to severe migraine attacks. These formulations include: nasal sprays, rapidly dissolving tablets (absorbed despite vomiting) and subcutaneous injections. These alternative forms of migraine-specific medications allow for both comfort and improved absorption, if a migraineur also has concomitant nausea and/or vomiting. Remember, triptans are contraindicated in individuals with ischemic heart disease, stroke, poorly controlled hypertension, or a hemiplegic or basilar migraine.

Antiemetics, like metoclopromaide (Reglan), which can be given intravenously or through the vein, are also good migraine therapies and are commonly given in the emergency department. Dihydroergotamine (D.H.E. 45, Migranal) is another option. This medication is injected or administered intranasally. Combining an intravenous antiemetic and dihydroergotamine is a potential option and also sometimes used in emergency departments for acute migraine treatment. Please note that dihydroergotamine cannot be used in conjunction with triptans and is absolutely contraindicated in pregnancy, and in individuals with poorly controlled blood pressure and/or heart disease.

Other treatment alternatives include an intravenous steroid, like dexamethasone, which is usually given in addition to other migraine therapies. Lidocaine is a less common therapy for migraines, that provides rapid relief, although recurrence is common. Lidocaine is typically administered through nasal drops, while the patient lies down with her head turned to the side of the head pain.

Summary

The take home point here is that nausea frequently accompanies head pain, which can exacerbate a migraine attack and/or make treatment more challenging, as migraineurs typically want to avoid taking a medication by mouth.

There are solutions, however, such as intranasal triptans or intravenous/subcutaneous medications that can be administered in an emergency department or a doctor’s office. If you do suffer from debilitating nausea with your headaches, please communicate this with your doctor so that alternative therapies to oral medications can be reviewed.

Sources

Gilmore B & Michael M. Treatment of an acute migraine headache. Am Fam Physician. 2011 Feb 1;83(3):271-280.

Lipton RB, Buse DC, Saiers J, Fanning KM, Serrano D, Reed ML. Frequency and burden of headache-related nausea: results from the American Migraine Prevalence and Prevention (AMPP study. Headache. 2013 Jan;53(1):93-103.

National Headache Foundation. Migraine patient survey. April 2010. Available at: http://www.headaches.org/NHF_Programs/NHF_Web_Surveys (accessed November 6th, 2013).

DISCLAIMER: The information in this site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.

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