From the Guidelines
Antiemetics play a crucial role in managing migraines accompanied by nausea and vomiting by allowing patients to better tolerate oral migraine medications and improving overall comfort during attacks. According to the study published in Nature Reviews Neurology in 2021 1, prokinetic antiemetics such as domperidone or metoclopramide can be used as adjunct oral medications for nausea and/or vomiting. These medications work by blocking the brain's vomiting center and reducing the distressing symptoms of nausea and vomiting.
When it comes to managing migraines with nausea and vomiting, it is essential to consider the use of antiemetics in conjunction with other migraine medications. The study recommends offering acute medication to everyone who experiences migraine attacks and advises the use of acute medications early in the headache phase of the attack 1. Antiemetics like metoclopramide can be taken at the onset of nausea symptoms and repeated as directed, typically every 6-8 hours as needed.
Some key points to consider when using antiemetics for migraines include:
- Using prokinetic antiemetics like domperidone or metoclopramide as adjunct oral medications for nausea and/or vomiting 1
- Taking antiemetics early in the migraine attack for optimal effectiveness
- Being aware of potential side effects like drowsiness and involuntary muscle movements
- Considering the use of antiemetics in conjunction with other migraine medications, such as NSAIDs or triptans, as recommended by the study 1
From the FDA Drug Label
In a placebo-controlled trial conducted in 468 males undergoing outpatient procedures, a single 4-mg intravenous ondansetron dose prevented postoperative vomiting over a 24-hour period in 79% of males receiving drug compared with 63% of males receiving placebo (P <0. 001). Two other placebo-controlled trials were conducted in 2,792 patients undergoing major abdominal or gynecological surgeries to evaluate a single 4-mg or 8-mg intravenous ondansetron dose for prevention of postoperative nausea and vomiting over a 24-hour period.
The FDA drug label does not answer the question.
From the Research
Antiemetics in Migraine Treatment
Antiemetics play a crucial role in the management of migraines, particularly those accompanied by nausea and vomiting. The primary function of antiemetics in this context is to:
- Relieve nausea and vomiting, which are common symptoms of migraine affecting at least 60% of patients 2
- Enhance the absorption of oral medications, such as analgesics or ergot preparations, which are often used to treat migraine headaches 3
Mechanism of Action
Antiemetics work by:
- Blocking dopamine receptors in the brain, which helps to reduce nausea and vomiting 4
- Stimulating gastric motility, which improves the absorption of oral medications 4
- Acting on serotonin receptors, which can help to alleviate migraine symptoms 5, 4
Commonly Used Antiemetics
Some commonly used antiemetics for migraine treatment include:
- Metoclopramide, which is a benzamide dopamine D2 receptor antagonist with 5HT3 receptor antagonist activity 3, 4
- Domperidone, a dopamine D2 receptor antagonist that does not cross the blood-brain barrier, making it relatively free of central side effects 3, 4
- Cisapride, a benzamide 5HT4 receptor agonist gastrointestinal prokinetic drug, which lacks dopamine antagonist activity 4
Treatment Approaches
Treatment approaches for migraines often involve a combination of antiemetics and other medications, such as:
- Analgesics, like acetylsalicylic acid or paracetamol, which are used to relieve headache pain 3, 6, 5
- Ergot preparations, like ergotamine or dihydroergotamine, which are used to treat moderate to severe migraine attacks 6, 5
- Triptans, like sumatriptan or rizatriptan, which are specific serotonin 5-HT1B/D receptor agonists used to treat acute migraine attacks 6, 5