A review published in 2022 in the journal Cells found that up to half of people with migraine reported experiencing nausea with their attacks over 50 percent of the time. What’s behind the throbbing headache and churning stomach connection? And more importantly, is there anything you can do to relieve nausea or vomiting when it comes with migraine? Here are some answers.
1. Is Nausea a Side Effect of Migraine?
Nausea is a common symptom of migraine — so common, it’s part of the diagnostic criteria, according to Roderick Spears, MD, endowed chair of migraine and chief of the headache division at Brown University in Providence, Rhode Island. Nausea doesn’t look the same for everyone with migraine. “In some people, if they have mild nausea, it might present as [not having] an appetite. They don’t want to eat, because they feel like they will get sick,” says Dr. Spears. “For more full-blown nausea, the person may be sweating, and if they don’t stop the migraine, they’re going to start vomiting.”
2. Is Nausea or Vomiting More Common With Any Specific Type of Migraine?
Nausea and vomiting can occur during a migraine attack with or without aura and are often found in vestibular migraine, a type that interferes with balance but doesn’t necessarily come with head pain. Symptoms of vestibular migraine can include vertigo and sensitivity to motion, according to Johns Hopkins Medicine. People with vestibular migraine usually experience motion sickness (car or sea) beginning in childhood and have a history of migraine with headaches.
3. Why Do You Get Nauseated During a Migraine Attack?
Nausea can happen in any phase of a migraine attack, but it most often occurs during the prodrome phase, which signals the beginning of the attack and can last for hours — or even several days, according to the American Migraine Foundation. “We don’t know exactly why some people experience nausea with migraine,” says Spears. Experts once thought that gastric stasis, which is when the stomach empties more slowly than normal, was the underlying cause of nausea in migraine. But 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. That said, the common denominator between nausea and migraine 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.
4. Can 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,” says Spears. It’s not entirely known why this is the case, although there are different theories. While throwing up may help stop a migraine attack, Spears doesn’t recommend trying to make yourself vomit. “The goal is to help patients avoid throwing up when that’s possible,” he says. If you do vomit, you should 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 healthcare system.
5. How Do You Relieve Nausea Caused by Migraine?
If you experience nausea as a migraine symptom, talk to your doctor to make sure it’s addressed in your treatment plan. “Almost all new migraine therapies treat what are 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. The migraine medications called ditans and gepants aim to shorten migraine attacks by targeting specific receptors on sensory nerves. These drugs are also designed to treat nausea and vomiting.
6. Can Eating Certain Foods or Skipping Meals Trigger Nausea or Migraine?
Eating certain foods or skipping meals can trigger migraine, which can then bring on nausea, 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. The foods that trigger a migraine attack vary from person to person, but processed meats, hard cheeses, and foods with a lot of preservatives in them are common culprits, says Lauren Doyle Strauss, DO, a headache specialist and assistant professor at Wake Forest University School of Medicine in Winston-Salem, North Carolina. You can overdo it on any food, though. “Moderation is a good idea. Don’t eat or drink anything to excess,” she says. Because skipping meals can trigger migraine attacks, it’s a good idea 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, or low blood sugar. Hypoglycemia may bring on a migraine or make it worse, according to the National Headache Foundation.
7. Can Nausea Make Migraine Treatments Taken by Mouth Less Effective?
In some cases, yes, nausea can decrease the effectiveness of acute migraine treatments taken orally, says Spears. “I find this is especially true for nocturnal migraines — the migraines that wake people from sleep. Often, the nausea is so [bad] at that point that taking an oral medication can be ineffective, so those individuals do need an alternative route of administration,” he says. Options include a dissolvable oral tablet, 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 in a different way may improve its efficacy, according to a presentation given by Simona Sacco, MD, at the 2021 Migraine World Summit. Early nausea can be an indication that there’s some impairment in how the gut is working. “This may lead to delay or incomplete absorption of an oral drug. If this is suspected, it’s better to use non-oral drugs,” said Dr. Sacco, a professor of neurology at the University of L’Aquila in Italy and the director of the neurology and stroke unit at Avezzano Hospital.
