From the Guidelines
Migraines cause nausea through a complex interplay of neurological mechanisms involving the trigeminal nerve system, brainstem, serotonin levels, and the autonomic nervous system. During a migraine attack, abnormal brain activity triggers the release of inflammatory substances, causing blood vessels to dilate and activating the brainstem, particularly the dorsal vagal complex that controls nausea and vomiting 1. This activation, combined with fluctuating serotonin levels, disrupts both pain perception and digestive function, leading to nausea. The autonomic nervous system becomes imbalanced, with increased sympathetic activity slowing digestion and contributing to nausea.
Some key factors to consider in the mechanism of migraine-related nausea include:
- The role of the trigeminal nerve system in triggering the release of inflammatory substances and causing blood vessel dilation
- The impact of serotonin level fluctuations on pain perception and digestive function
- The effect of autonomic nervous system imbalance on digestion and nausea
- The potential for vestibular disturbances to affect balance centers in the brain and worsen nausea symptoms
For patients experiencing migraine-related nausea, consider using a nonoral triptan and an antiemetic, as recommended in the clinical guideline from the American College of Physicians 1. Antiemetic medications like metoclopramide, ondansetron, or promethazine can provide relief when taken early in the migraine attack, and they can be used alongside migraine-specific treatments like triptans. Non-oral forms of migraine medications, such as nasal sprays, injections, or suppositories, are particularly helpful when nausea makes swallowing pills difficult.
It is essential to counsel patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy to improve efficacy, and to highlight the importance of lifestyle modifications, including staying well hydrated, maintaining regular meals, and managing stress 1. By understanding the complex mechanisms underlying migraine-related nausea and using evidence-based treatments, healthcare providers can help improve patient outcomes and reduce the morbidity and mortality associated with migraines.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Mechanism of Migraine-Induced Nausea
- Migraine is a complex disorder characterized by symptoms such as headache, nausea, vomiting, photo- and phonophobia, and malaise 2.
- Nausea and vomiting are common symptoms of migraine, affecting at least 60% of patients, and can be more disabling than the headache itself 3.
- The exact mechanism of migraine-induced nausea is not fully understood, but it is thought to be related to the activation of serotonin receptors and the release of neurotransmitters that stimulate the vomiting center in the brain 2, 3.
Treatment Options for Migraine-Induced Nausea
- Triptans, such as sumatriptan, are effective in treating migraine attacks, including nausea and vomiting 2, 4.
- Antiemetic drugs, such as metoclopramide, may also be effective in relieving nausea and vomiting associated with migraine 4.
- Other treatment options, such as ergotamine and dihydroergotamine, may be less effective or have more side effects 2.
- Preventive therapies, such as anticonvulsants, antidepressants, and beta blockers, may also be effective in reducing the frequency and severity of migraine attacks, including nausea and vomiting 5.
Pharmacological Options for Migraine Treatment
- Eletriptan, a selective serotonin 5-HT1B/1D agonist, is a first-line treatment option for moderate-to-severe headache attacks, including nausea and vomiting 6.
- Other triptans, such as almotriptan, frovatriptan, naratriptan, rizatriptan, and zolmitriptan, may also be effective in treating migraine attacks, including nausea and vomiting 2, 6.
- The choice of treatment depends on the individual patient's characteristics, such as the presence of cardiovascular risk factors, and the specific symptoms and severity of the migraine attack 2, 6.