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.

Anti-emetics

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.

Natural remedies

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.

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

View Comments (16)
  • vsurdel
    1 year ago

    Phenergan suppositories work wonders, but will also put me to sleep for hours. That’s fine, then I don’t feel the migraine. However, when I took phenergan tablets, I was told that I slurred my words – and I didn’t realize it. Had to stop taking it at work.

  • maria.deleon moderator author
    1 year ago

    Vsurdel thank you for your comment ..that’s because phenergan can be very sedating. I know the first time I received I slept for 15 hours best sleep ever! Not good if have to work 1) doses can be adjusted to pedi doses 12.5 mg 2) typically with recurrent use it loses sedation effect not entirely but much less. 3) try other antiemetic – the slurring isn’t because you were sedated.. best of luck Maria de León / author/ advocate / moderator

  • RoseDM
    1 year ago

    I often use a cold (ice)pack to the back of the neck which disrupts the signal that’s sent between head to stomach, tamping down the nausea. FYI, it works for any nausea; migraines, motion sickness, morning sickness. etc..

  • maria.deleon moderator author
    1 year ago

    RoseDM..great advice, simple tecniques which can prove useful for many in a pinch. Thank you. Have a great weekend. Maria de León / moderator/ patient advocate

  • maria.deleon moderator author
    1 year ago

    Ann thanks for your comments. Maria de León / moderator / author / patient advocate

  • James Weil
    1 year ago

    I have been prescribed Promethazine for migraine nausea. My usual rescue treatment is to start with a using a NeliMed bottle to flush refrigerated saline solution through my nose. Wait 15 minutes. If the migraine is still present take a Rizatriptan melt tab with a Promethazine tablet. If relief occurs within an hour, followup after 1 hour with a Naratriptan. However mindfulness exercises often work better than medication. One of the latest tools that work for me is to watch on YouTube, David Solis 60 minute orchestrated version of Yurami’s “The River Flows In You” . By the time I finish watching this video with incredible time lapse scenery, my migraine is often gone without medication.

  • maria.deleon moderator author
    1 year ago

    Thanks for your input James ..yes meditation and relaxation do have a powerful role. Glad works for you. But, if I make a suggestion next time you have headache come on don’t wait to start maxalt ..take it immediately ..are you taking naratriptan only when headache persists? Hav you ever maximized rizatriptan dose 30 mg in 24 hours? Maria de León / author/ moderator/ patient advocate

  • JanetH
    1 year ago

    Ann-coke syrup is awesome. I keep a coke at work for migraines, preferably a “Mexican” Coke (made with cane sugar vs. corn syrup). In Michigan, many of us swear by Vernor’s (originated in Detroit) for stomach problems.

  • maria.deleon moderator author
    1 year ago

    I agree that mexican Coke’s much better and sweeter and in some cases simply ingesting caffeine or caffeinated drinks helps ease headache ..glad coke ( mexican) works for you..I am craving one now. Have a great day. Maria de León / author/ moderator/ patient advocate

  • Soteria
    1 year ago

    Reading this after having one of the worst (and sudden onset) migraines in past 10 years – vomiting non stop for over 12 hours – (there’s nothing left to vomit but you keep trying) ended up in ER and had to go by ambulance (for the first time) as I was so weak I couldn’t stand. ER Doctor gave me an IV “cocktail” of Phenergan (which I had never heard of before) and a potent NSAID ( which usually doesn’t help) The Phenergan must have worked because the uncontrollable retching stopped. Its now 5 days later and I’m still feeling weak from this one but slowly regaining strength. However he said that Phenergan was not a RX they can prescribe – it has to be administered via IV – he gave me a script for Zofran instead (which I have used before but it doesn’t help taking a pill if nothing stays down). Does anyone know anything about this? Migraines are bad enough but the ones with the nausea I wouldn’t wish on anyone. You literally feel like you’re dying. Sorry to sound so dramatic but it’s hard to describe how effing horrible you feel to people who haven’t experienced it. Those that have totally understand.

  • alphabet
    1 year ago

    I hope you are feeling better Soteria by the time you read this! Heaving nothing but bile Is one of my least favorite parts of migraine! The next day feeling like you’ve been hit by a bus, stomach hurts, kidneys hurt, back hurts!
    I have Phenergan in various formats – suppositories are most helpful when you can’t keep anything down but they also come in pills and syrup. If you have a compounding pharmacy anywhere near you they can even make it into a lotion/cream you rub on your wrist. Phenergan is a pretty generic and inexpensive medication with many applications, not sure why the ER doctor couldn’t prescribe it for you but your GP should be able to. Relpax , Ice pack, barf bag, phenergan suppositories my go to’s.
    For what it’s worth I have noticed that when I exercise regularly I experience fewer migraines a month dropping from 8 – 12 a month to 6 – 8! Feel well soon fellow migraineur!

  • maria.deleon moderator author
    1 year ago

    Alphabet thnaks for sharing this great advice which Is what i was trying to say but perhaps not as clear. continue feeling better maria de León / author/ moderator / patient advocate

  • maria.deleon moderator author
    1 year ago

    Soteria ..i am so very sorry i have been there ..vomiting even when stomach is empty is the pits..I am sure you got dehydrated ..make sure eating and drinking plenty of fluids. As I mentioned above in article phenergan can be compounded to a gel to apply to wrist or even given in suppositories . Also Zoltan come stay in a dissolvable tablet so don’t have to swallow. Talk to your doctor. You probably got toradol ( powerful nsaid) used by many including me in my patients to break cycle. Good luck.
    Maria de León / author moderator / patient advocate

  • Loveday1974
    1 year ago

    Years ago a nurse in the ER gave me alcohol swabs to smell to help with my nausea. It helps me get thru the nausea while I wait for refill from medications. It is not a cure for the nausea but it really helps me.

  • maria.deleon moderator author
    1 year ago

    Loveday1974 thnak you for sharing have never used but glad it works for you. Maria de León moderator/author/ patient advocate

  • Ann
    1 year ago

    Coke syrup is the best for me. Buy it at your local drugstore.

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