Migraines: When Nausea Is As Bad As The Headache

Published on December 11, 2011 in Diseases & Conditions


For some people, the worst thing about a migraine is not the pain – it’s migraine nausea.

Nausea and vomiting are two very distressing symptoms accompanying migraines in some people. About 80% of migraine sufferers get nauseous, but only 30% actually throw up. In rare occasions, a person may vomit so many times they actually become dehydrated.

Most of the time, simply treating the migraine relieves the nausea. However, the nausea and vomiting may be so bad that it actually prevents a person from taking their migraine relief medications. When this happens the nausea only serves to prolong the agony.

There are two types of migraine nausea:

  • Nausea that’s caused by extreme pain from any source – whether it be from a headache, neck or back pain, or abdominal pain.
  • Nausea produced by the brain sending signals down the vagus nerve into the stomach causing acute queasiness.

In the first instance, standard anti-nausea medications may be used to relieve symptoms. These medications may be taken orally as pills – or in severe cases where someone just cannot hold down anything – as rectal suppositories.

Examples of standard anti-nausea medications include:

  • Phenergan (promethazine hydrochloride)
  • Thorazine (chlorpromazine)
  • Compazine (prochlorperazine)
  • Tigan (Trimetho-benzamide hydrochloride)
  • Reglan (metoclopramide hydrochloride)
  • Gravol (dimenhydrinate)

All of the above are available in suppository form except for Reglan.

One natural method that delivers real benefits is ginger. Taking ginger in the form of tablets or even a tea has been shown to alleviate some of the nausea accompanying a migraine, as well being effective for other conditions, including motion sickness, pregnancy and vomiting after surgery.

For the type of nausea primarily caused by the brain itself, the activity that causes the migraine also causes the nausea. This is where the “triptan” drugs are used.

Effects of Triptans on Migraine Nausea

Triptan drugs have become the primary migraine prescription medication used since the 1990’s. Examples of triptans include:

  • Imitrex (sumatriptan)
  • Maxalt (rizatriptan)
  • Amerge (naratriptan)
  • Zomig (zolmitriptan)
  • Axert (almotriptan)
  • Frova (frovatriptan)
  • Relpax (eletriptan)

A 2001 study comparing four of the triptans concluded that Maxalt and Zomig were more effective at relieving nausea associated with migraines than Imitrex or Amerge. Of course about a third to a half of the patients in the study got better in two hours based simply on the placebo effect.

This isn’t to say that triptan medications should be used to combat nausea in non-migraine situations. Triptan medications don’t directly affect the nausea itself – they work in alleviating the migraine – which in turn eases the nausea.

As with any oral medication, unless you can keep it in your stomach – it’s not going to do you much good. Of the above triptans, all come in oral forms, but some can be taken in ways other than swallowing a pill.

There are 5 possible triptan formulations available:

  • Standard oral tablet (all triptans)
  • Subcutaneous (under the skin) injection (Imitrex)
  • Quick dissolving oral tablet (sub-lingual) (Maxalt, Zomig)
  • Nasal spray (Imitrex, Zomig)
  • Rectal suppository (Imitrex)

For example, Imitrex comes as an injection, which is fast acting and relatively effective, but has a host of unpleasant side effects and is extremely expensive. Imitrex has recently become available as a nasal spray and also comes as a rectal suppository.

Zomig and Imitrex are the only two triptans that are available as nasal sprays. Sprays have the advantage of being rapidly absorbed and being quick acting – with relief coming as early as 15 minutes after use.
Zomig and Maxalt are also available as quick dissolving sub-lingual (under the tongue) tablets, doing away with any problems associate with swallowing.

The triptan formulations offering an alternative to swallowing a pill allows patients the opportunity to possibly abort a migraine attack at its onset. This is very reassuring to those migraine sufferers who frequently encounter nausea – especially vomiting.

Early administration of treatment, particularly the triptans, during a migraine attack is vitally important. The preferred method of taking conventional pills and tablets is perfectly reasonable – so long as the patient is able to swallow and keep the medication down long enough for absorption to take place.

However, in situations where nausea with or without vomiting is frequent or likely, alternate forms of the triptan medications should be carefully considered.

A Better Method

There is another option – a migraine cure. Cure the migraine and never worry about nausea or vomiting again.

Recent reports indicate migraine headaches can indeed be totally abolished – as a number of elite medical clinics catering to women have testified. Under their treatment protocols, migraines are completely eliminated in 80% of their patients.

These successes are limited to women only, as addressing a women’s hormones is the basis of the cure. Some clinics have published their treatment protocols and even made them available to the public.