How can I keep my Migraine medicines down so they will work?
Nausea and vomiting are a part of Migraine that none of us welcomes, but most of us experience. Although you can have a Migraine attack without it, nausea and/or vomiting are extremely common symptoms for patients. When a Migraineur is suffering nausea and vomiting, keeping the medicines in their stomach to treat their attack may not always be possible. Add to that the fact that some Migraine medicines themselves can cause nausea and vomiting, and it’s easy to see how some patients find themselves in a no-win situation. This leaves some Migraineurs little or no choice but to seek help from their doctor either in his/her office or the Emergency Department.
Unfortunately, Migraine patients often do not receive the best care in these emergency situations. If you are a Migraineur who frequently has this problem, some treatment choices you might want to consider include:
- Anti-emetics - medicines that can be taken to alleviate some of the nausea. Sometimes called anti-nausea medication, there are several your doctor has to choose from. PRO - These medicines tend to be very effective. Sometimes anti-emetics can be used with rescue pain medicine and the affect is synergistic (better than either of the two alone). CON - There are significant side effects that must be considered very carefully before taking most types of prescription anti-emetics. Some of those side effects your doctor may not think to mention include avoidable movement disorders like akathisia, dyskinesia, tardive reactions like tardive dystonia, and acute dystonic reactions, which can be serious and permanent. Here is a list that mentions many of the most common medicines that can cause these reactions. Unfortunately, outside of movement disorder specialists, it is not widely recognized that this can happen even with the very first dose of this type of medicine. One type of anti-emetic - ondansetron - is known to be much safer than more common older types of anti-nauseants, but is much more expensive. Often patients find they must specially request this medicine. Additionally, you'll want to ask your doctor about combining anti-emetics and other medicines that cause drowsiness, as adding too many things together can make you stop breathing. Unfortunately, many of these prescriptions will come in a tablet form, so if vomiting is a frequent symptom of your Migraine attacks, you may want to mention it to your doctor and request another non-oral form of the medicine. Anti-emetics frequently come in suppository form. Not a glamorous delivery system to be sure, but fortunately it is very fast and effective. OTC medicines like dimenhydrinate - an antihistamine - are for motion sickness. They work on the inner ear not the stomach, and may not help the nausea of a Migraine attack.
- Compounded medicine - Migraine medicine does not always need to be taken orally. Most medications can be formulated into various different forms. This is done at a special pharmacy called a Compounding Pharmacy. A medicine normally taken as a tablet may often be changed to a liquid, a suppository, a topical cream, a patch, a nose spray, a lollipop, or an injection. Some of these customized options can bypass sensitive digestive systems and often result in much faster relief than typical tablets.
- Warm water chaser - A nurse's trick for faster absorption. Oral medications should always be taken with lots of water. If you are limited to an oral medicine, you may want to talk to your doctor or pharmacist about taking it with a small bit of cool water, followed by a chaser of warmed water instead of more cold water. Cold water tends to make sensitive stomachs worse. Warm water not only tends to ease the stomach, but in many cases results in medicine finding its way to the bloodstream much faster than normal. Some medicines may be taken with hot water for very fast absorption, but you'll want to check with your doctor or pharmacist before trying this. Some pills will break down very fast in warm water and you want to be sure it's in the stomach before that happens, so the warm water should be a chaser only.
- More holistic complementary therapies for nausea and vomiting include Ginger - fresh ginger tea, ginger capsules, ginger ale, ginger candy and cookies. Ginger is a frequently used anti-emetic herb that has the added bonus of helping curb inflammation. If the flavor is too strong, try disguising it with honey which masks the ginger flavor. Coke syrup - an old timey method to relieve nausea, coke syrup also contains caffeine which may be helpful as a Migraine abortive or harmful as it may cause rebound, so use your good judgment. Syrup is available where fountain drinks are sold, and can be very helpful. Sugar may also work as well as Coke syrup but doesn't contain the phosphoric acid or caffeine. Emetrol - available over the counter, it is the more expensive version of Coke syrup. It contains the phosphoric acid and sugar of Coke, but without the caffeine. Diabetics will probably want to find other options. Acupressure - Works like acupuncture on a specific point said to affect nausea. Hand: Apply pressure to the webbing between the thumb and index finger of the hand. Be firm and use deep pressure with a rapid massaging motion for several minutes. Foot: rub the thumb or thumbnail on the top of the foot between the tendons of the second and third toes. Again, this is firm, not gentle massaging motion for several minutes.
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