Nausea frequently marks the onset and progression of a migraine, serving as a telltale precursor or accompaniment to the throbbing headache. Its occurrence is not limited to any specific timeline, as sufferers might experience it prior to, in conjunction with, or following the peak of the headache. Fortunately, a range of treatments, including anti-emetic medications and complementary therapies, offer relief.
Individuals with migraines can have vastly differing experiences, with nausea as a variable symptom; in some, it leads to vomiting, while in others, it does not. Importantly, it is not discriminating in terms of migraine type, affecting those with both aura and without.
The intertwining of nausea with migraines is corroborated by a substantial 2019 study encompassing 6,045 migraine patients, where approximately two-thirds reported concurrent manifestations of nausea, alongside sensitivity to light and sound. For about 28%, nausea presented as the most disruptive symptom associated with their migraines.
According to the American Migraine Foundation, the nausea associated with migraines can manifest during either or both the prodromal phase – which can span hours to days before the headache hits – and the actual headache phase, potentially enduring anywhere from 4 to 72 hours. Some people even experience nausea during the aura phase, which can serve as an interlude between the prodrome and headache.
The prevalence of nausea throughout different migraine phases was further evidenced in a 2012 study, where it was reported as a component of the aura in over half of the 861 migraine attacks analyzed.
But what drives this nausea in migraines? Science hasn’t completely unraveled this mystery yet. A hypothesis from a 2018 research review suggests that common migraine triggers may incite the pathways of the central nervous system, which is responsible for regulating autonomous functions such as heart rate and digestion, thus leading to nausea and vomiting as expressions of an altered autonomic system.
Gastroparesis, a condition marked by delayed gastric emptying and commonly accompanied by nausea and vomiting, is another condition observed in some migraine sufferers, indicating a possible link between the two conditions.
Navigating Nausea in Migraines Across Different Types
While the International Classification of Headache Disorders (ICHD-3) integrates nausea into the diagnostic criteria for migraine without aura, its presence is not a determining factor for migraine with auras according to the classification.
Per ICHD-3 standards, an individual must exhibit either nausea and vomiting or heightened sensitivity to light and sound during a headache for a diagnosis of migraine without aura to be considered. However, it’s worth noting that many people who undergo migraines with aura still report experiencing nausea during their episodes.
Strategies for Managing Migraine-Induced Nausea
Should you find yourself grappling with nausea during a migraine, avenues for alleviation are available through both prescription and over-the-counter medications, as well as alternative or at-home remedies.
Anti-nausea Medications (Antiemetics)
Doctors may prescribe antiemetics for the management of nausea and vomiting during migraine episodes. Some commonly recommended antiemetics, as identified by the American Academy of Family Physicians, include:
- Chlorpromazine
- Droperidol
- Metoclopramide
- Prochlorperazine
- Promethazine
These medications come in various forms — such as nasal sprays, sublingual tablets, or liquids — to facilitate easier ingestion for individuals during bouts of nausea and vomiting.
Acupressure
Practitioners of acupressure apply targeted pressure to specific body points to alleviate symptoms. Unlike acupuncture, this technique is needle-free and has been shown to be potentially beneficial for nausea related to migraine.
Ginger
A renowned natural remedy for nausea, ginger has demonstrated efficacy not just for treating nausea associated with migraines, but potentially for other migraine symptoms as well. A 2020 mini-review spanning three studies indicated that ginger could reduce pain within two hours and resulted in decreased vomiting and nausea in the experimental groups compared to controls.
Aromatherapy
The therapeutic use of plant extract aromas, or aromatherapy, includes some evidence supporting peppermint essential oil as a palliative tool for nausea.
A 2020 study with 80 cancer patients undergoing chemotherapy revealed that those who used a drop of peppermint oil on their upper lips thrice daily over five days, in conjunction with antiemetic medication, reported reduced nausea and vomiting compared to those who solely relied on antiemetic drugs.
Decoding the Migraine-Nausea Connection: Strategies to Avoid the Queasy Feeling
Navigating migraine attacks often involves coping with the disabling accompaniment of nausea, a disquieting symptom that some might consider even more debilitating than the headache itself. Mitigating or averting this unwelcome guest could lie in effective migraine management strategies.
Embracing a holistic approach to your lifestyle can be pivotal. The SEEDS strategy encapsulates essential lifestyle modifications — ensuring adequate sleep, engaging in regular exercise, eating a consistent diet of balanced meals, diary-keeping of headache patterns, and stress management. Each component is intended to strengthen your defense against the onslaught of migraines and the ensuing nausea.
Understanding and sidestepping personal migraine triggers is another cornerstone of prevention. Comprehensive tracking of your migraine patterns may furnish insights into specific environmental or dietary factors that precipitate your attacks, empowering you to diminish their frequency through avoidance.
A varied arsenal of medications also stands at the forefront of migraine prevention. Beta-blockers, antidepressants, antiseizure drugs, calcium channel blockers, and calcitonin gene-related peptide antagonists are among the prescriptions that may be advised to thwart or reduce the incidence of migraines.
Complementing these are alternative treatments like yoga, relaxation techniques, biofeedback, and cognitive behavioral therapy, which harbor the potential not just to decrease the number of attacks, but in some cases, forestall them entirely.
For those who experience nausea during the latter stages of a migraine, prompt intervention with acute treatment medications at the earliest signs of an attack could avert the possibility of vomiting the medications, maintaining their efficacy in pain relief and symptom management.