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.
This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

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  • Ellen Schnakenberg author
    5 years ago

    Hi Jamie,

    Thank you so much for your reply and your suggestion of Ginger Brew. It sounds wonderful, but my interstitial cystitis keeps me away from ginger, which is unfortunate because it is so helpful to me, but also because I just bought two large bottles of capsules! Let me clear a couple of important facts however, for the benefit of other readers and dystonia advocacy – something else that is an ongoing passion for me…

    While each person’s experience will be different, there are different movement disorders and any can be experienced by a patient. Dyskinesia is a *kissing cousin* of dystonia, however, it is not the same. Dystonia can indeed be caused by these medications and many more. Dyskinesia can also be caused by many of these same medicines and become a permanent problem, just as dystonia can. This means your correction is not a correction, but an addition to the point I was making. I could not mention all movement disorder side effects since this wasn’t a movement disorder post, but did begin addressing them separately elsewhere on this site. Unfortunately, the links apparently didn’t stick, so I will have to replace them, but, so you will receive them in your reply email, I’ll include them at the end of this reply.

    There is a l-o-o-o-n-g list of medications that can cause these medication related movement disorders. Here’s the fastest, easiest way I can relate to you how they work: The brain’s chemistry needs to be balanced. When unbalanced, sometimes these meds can help *rebalance* the problem and can be helpful. Sometimes they be toxic, cause more unbalance, and make the problem worse. This toxicity can be dangerous and damage the brain, causing permanent problems. The avoidable medications list provided by several dystonia organizations (I will link to the most complete I can find right now) will remind patients that what may be one man’s treatment is another’s poison. Cogentin is one of those BECAUSE of its anti-cholinergic properties which can cause movement disorders. It can be very confusing, because Cogentin and other meds on the list, are often used to help those in an acute situation too! In the list linked below, as well as the following articles — instead of choosing to mention every drug in a class, they instead tell you the classes of medications as well as the property of the medicine that is dangerous. Any medications with those properties have the potential to trigger a movement disorder in specific people who are susceptible to them.

    Movement disorders are widely misunderstood even by non-specialist physicians, and many patients have questions about them. I always encourage them to see a movement disorder specialist who can further explain what I can’t answer for you here. Dystonia (tardive, acute related to meds, and generalized which is non med related, except the meds can trigger it) is something I’ve had to live with for a long time. I’ve also had akathisia and dyskinesia, but thankfully those went away. The akathisia typically goes away when the drug is out of the system. The dyskinesia can also be permanent, but in my case only stayed with me in a minor (rare lip smacking or *kissing* movements) for a few years and seems to be gone now. Perhaps its time for some articles on those movement problems too?!

    My Aunt lived with all of these in a day when medication choices were few and the side effects not understood. I still remember vividly how she struggled and eventually died, and the visits to the nursing home she ended up in where we had to leave when the movements became unbearable and exhaustive for her. When my mom got them, she was scared and embarrassed, and to this day won’t tell her doctors she has them in her hand. Mine are much worse, and I advocate for dystonia whenever possible because so many Migraine patients end up on these meds and with these problems, and are not diagnosed, just as I was. Thankfully I have some amazing resources now, including my physicians, American Headache Society conferences, as well as a fellow dystonia pal with a doctorate in neuroscience who is amazing whenever a new drug pops up and I need to know if it’s going to be a problem. Soon I hope to have a more complete listing containing newer Migraine med options such as memantine, on my personal website for reference in patients that need more complete information. Hopefully large movement disorder foundations will soon update their own public lists too so they are more complete. Otherwise, be careful with any medicine that has the properties/effects listed in the avoidable meds list I post below.

    Migraine Triggers and Comorbidities: Dystonia http://migraine.com/blog/migraine-triggers-and-comorbidities-dystonia/

    Dystonia/Spasmodic Torticollis Avoidable Medication Printable List http://www.spasmodictorticollis.org/media/pdf/Broch-Meds.pdf

    Good luck and hang in there 🙂

    ~Ellen

  • Nikki Wills
    7 years ago

    My Doctor now has me on Metoclopramide to help with my nausea. It’s also supposed to help me better absorb my medications. It’s not a long term fix because you can only be on it max 12 weeks at a time but I hope it works. Good news is I don’t have to take it every day, only when I have severe nausea or vomiting. I’ll be honest though, I find the list of possible side effects a little scary. We’ll see I guess.

  • Leah S. Wark
    7 years ago

    Good ideas I will try some of these next time.

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