Tips for Treating Nausea in Migraine
Having lived with migraines nearly my entire life I can tell you that with the exception of a pain in the head, that hits like a brick thrown at you suddenly, the sensory component of migraines is the most bothersome.
Among the sensory components which can last for hours and days is nausea. When it hits suddenly or lasts on and on can be a horrible experience especially if is so severe you actually end up vomiting.
So how do we deal with this pesky problem that can turn our life upside down?
There is nothing worse than being nauseated especially when you can’t find a treatment for it.
Use of triptan
At the onset of nausea even if there is no actual pain in the head, I have found that taking a triptan like Imitrex, Maxalt etc. can alleviate the problem and even prevent the unfolding of a full blown migraine. Since the pills can take up to an hour to work, I typically have used and recommended either the nasal spray formulation of Imitrex, or the melt tabs of Maxalt and Zomig. These not only are faster acting than the traditional oral forms but also bypass the gi tract. It's important to try to avoid letting the nasal sumatriptan (Imitrex) drain into your throat which can worsen nausea. To avoid this make sure you tilt your head back for a few seconds while you administer the drug. The downside of using repeated nasal spray is that it can cause nose bleeds with repeated use as it did for me.
There are several compounds that I have used for treating nausea associated with migraine. In cases where there is a pregnancy and the patient is unable to take standard oral migraine medications, anti-emetics will also improve or reduce an actual migraine. The other reason I like these is because many of them have an alternate route of administration bypassing the stomach.
- Phenergan (suppositories, injection, gel applied to wrist). Your doctor can ask a pharmacist that knows how to compound meds to make a paste/gel and place in syringes which are refrigerated and used as needed for nausea. I used these lots for my patients and for my daughter when was little and got motion sickness from migraine. I rubbed in her wrist and kept her from throwing up.
- Zofran (pill, sublingual). The sublingual form is the best for sudden nausea. However, you can’t take it more often than every 12 hours. This is my preferred drug to use for myself and for my patients when the triptans don’t resolve nausea.
- Compazine (pill, syrup, suppositories, injection).
- Visteril (pill, syrup, injection). Many people don’t think of this option because it's usually used as an allergy medicine. However, in a hospital and in a clinic, I preferred this because it does not have the potential of causing abnormal movement disorder with repeated long-term use like Phenergan and Compazine have. Your doctor may even give you a vial to inject yourself or have someone inject you if nausea severe and can’t take oral meds.
- Domperidone (pill) this medicine not available in the US, however, I have prescribed for many patients who do not respond to other anti-emetics. I personally take it when my nausea is severe. A prescription from a physician is needed and it can be accessed at a reputable pharmacy in Canada.
Mint tea or peppermint oil (either in tea, infused as vapor, applied to belly and temples)
Ginger(pills, tea, and root as a tea, pickled). I prefer either buying root and boiling to make tea or eating pickled ginger.
Next time before you find yourself feeling green from nausea consider discussing one of these options with your physician.
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