From the Guidelines
Gastric symptoms commonly associated with migraines include nausea, vomiting, abdominal pain, loss of appetite, and diarrhea. Nausea is particularly prevalent, affecting up to 90% of migraine sufferers, while approximately one-third experience vomiting during attacks 1. These symptoms often occur during the prodromal or early phase of a migraine and may persist throughout the headache. The connection between migraines and gastric symptoms stems from the involvement of serotonin pathways and the trigeminal nerve system, which affect both brain function and gut motility. Additionally, the vagus nerve plays a role in this brain-gut connection. For migraine patients experiencing severe nausea and vomiting, antiemetic medications such as metoclopramide (10mg), ondansetron (4-8mg), or prochlorperazine (5-10mg) can provide relief 1. These medications not only address gastric symptoms but may also enhance the absorption of migraine-specific treatments like triptans. Some patients find that treating their gastric symptoms early helps improve overall migraine management and reduces attack severity. Key points to consider in managing gastric symptoms associated with migraines include:
- Early treatment of nausea and vomiting with antiemetics
- Selection of a nonoral route of administration for patients with significant nausea or vomiting
- Consideration of concomitant treatment with an antiemetic and an oral migraine medication
- Education of patients about the importance of managing gastric symptoms as part of overall migraine management. It is essential to note that while the provided evidence is from 2002, the principles of managing gastric symptoms in migraines remain relevant, emphasizing the need for prompt and effective treatment to improve patient outcomes 1.
From the Research
Gastric Symptoms Associated with Migraines
The following gastric symptoms are associated with migraines:
- Gastroparesis: a chronic stomach disorder manifested by delayed emptying of solids and liquids without evidence of mechanical obstruction 2
- Functional dyspepsia: a disorder characterized by delayed gastric emptying, which is also a symptom that commonly occurs with migraine attacks 3
- Cyclic vomiting syndrome (CVS): a disorder characterized by recurrent attacks of nausea, vomiting, and/or abdominal pain lasting hours to a few days, with symptom freedom between attacks 3, 4, 5
- Nausea and vomiting: prominent symptoms in CVS, which are also symptoms that commonly occur with migraine attacks 3, 4, 5, 6
- Abdominal pain: a symptom that may arise from a number of different causes, including abdominal migraine and CVS 4, 5
Clinical Implications
The association between migraine and gastric symptoms has important clinical implications, including:
- Delayed gastric emptying and vomiting may affect oral dosing compliance, and thus, the absorption and efficacy of oral migraine treatments 3, 2
- Non-oral formulations that do not rely on gastrointestinal absorption may be necessary for the treatment of migraine in patients with gastric symptoms 2
- The importance of recognizing GI disorders in patients with migraine, as many patients do not find adequate relief with oral migraine therapies 3