March 07, 2024
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Nausea is a common symptom of migraine. There are a number of options for relieving nausea, like home remedies, over-the-counter (OTC) medications, and treatments like massage and acupuncture.
In the migraine community, there’s an oft-used term. You may know it well: “Most bothersome symptom.”
Some say it’s the throbbing, pulsing head pain. Others say it’s the sensitivity to sound and light. Still, others name nausea as the symptom they dread the most.
Read on to learn how to manage migraine-related nausea, plus why it happens.
There’s some evidence to support certain home remedies and lifestyle supports for migraine. These might include:
Neil Patel, MD, a neurologist at Stony Brook Medicine, says that ginger can have a soothing effect on the stomach, which can ease nausea.
Megan Donnelly, DO, the head of the Novant Comprehensive Headache Center, agrees, and some research supports the idea.
For instance, one small 2020 review of three randomized controlled trials showed that ginger was associated with substantially improved pain scores compared with the control group.
Donnelly says avoiding foods that worsen nausea during migraine attacks is reasonable, but she adds a caveat.
“People think certain foods cause their migraine … really, what happens is people get food cravings in their pre-migraine phase,” Donnelly says. “The migraine is already about to happen. They have this craving. They eat the food and get a migraine.”
This is an example of correlation, not causation.
“They were going to get the migraine one way or another, so it’s important not to vilify foods,” says Donnelly.
However, some people find certain foods make migraine symptoms like nausea worse, while others have a more positive effect.
“Foods can be soothing,” Donnelly says. “Just a little bit of food can curb the acid content in the stomach, especially if it is a simple carb like a cracker. It’s easily broken down. It’s not this heavy, high protein or fiber food where the stomach has a lot of work to do.”
Fred Cohen, MD, an assistant professor of medicine and neurology for the David S. and Ruth L. Gottesman Center for Headache Treatment and Translational Research, suggests keeping a food diary to determine what foods do — and don’t — work for you.
Donnelly says there’s some emerging research around cannabis’ role in easing nausea, but she and Patel agree it’s too soon to make any definitive statements about its benefits.
A 2022 systemic review indicated that medical marijuana might reduce the frequency and length of migraine episodes, pointing to some research, including a study from 2018, that cannabis might reduce migraine-related nausea. Still, the authors agreed more robust research is needed.
Patel says some vitamins and supplements may help with migraine-related nausea, though he cautions research is limited.
These vitamins include:
A 2022 review of nine articles noted that supplementing with riboflavin (vitamin B2) at 400 milligrams (mg)/day for 3 months had a significant effect on the duration, frequency, and pain scores of migraine attacks.
A 2021 study indicated that taking 500 mg of magnesium oxide might be as effective as taking valproate sodium in reducing migraine frequency (which, in turn, would reduce nausea related to migraine attacks).
The National Center for Complementary and Integrative Health indicates that feverfew might help with nausea but that digestive issues and nausea can also be a side effect.
Cohen suggests speaking with a provider before taking any vitamins or supplements, as some may be contraindicated with other medications you’re taking.
Donnelly notes that turmeric has antioxidant properties, but data don’t currently conclusively support its effect on migraine-related nausea.
Anecdotally, Patel notes some people he’s treated say it’s helped them.
A small, 8-week 2021 randomized controlled trial of 44 women who received twice-daily Curcumin supplements, found in turmeric, noted a decrease in the duration and severity of headaches compared to the placebo group. However, the difference in the frequency of attacks was marginal.
Those who experience migraine nausea can also try easing it with OTC treatments.
These include oral antihistamines, like:
Sumatriptan, a migraine medication, can also be helpful.
“Dramamine and Benadryl are the two most common over-the-counter nausea medications,” says Adil Niaz, DO of Jersey Shore University Medical Center. “Both are medications known as antihistamines, which reduce the level of a chemical in our body known as histamine, which goes and acts on the brain to reduce nausea.”
The downside, Donnelly points out, is that these drugs can have a sedative effect.
It’s important to discuss any prescription medication with your doctor first, as different interventions will work best for different people. Zofran (ondansetron) and Reglan (Metoclopramide) are the most commonly recommended prescription medications.
However, Reglan can have side effects, including tremors. For this reason, providers often suggest Zofran first.
While doctors say it will vary from patient to patient, complementary and alternative therapies may assist with nausea related to migraine. These treatments may include:
Patel says aromatherapy, specifically peppermint smells, can help some people ease nausea during migraine attacks. Others have told them peppermint-scented chapstick helps.
According to a 2020 review, there are 10 types of plant essential oils that could relieve migraine symptoms by inhibiting inflammation in the nervous system, sensitivity to pain, and blood vessel tension.
Some of these oils include:
However, Patel cautions that certain scents may be irritating to some, so following your body’s cues is important.
While research suggests there are health benefits, the FDA doesn’t monitor or regulate the purity or quality of essential oils. It’s important to talk with a healthcare professional before you begin using essential oils and be sure to research the quality of a brand’s products. Always do a patch test before trying a new essential oil.
Patel says that acupressure might help some, but different practitioners may perform it differently.
A small 2017 study of 98 people with chronic migraine with aura indicated that acupressure combined with sodium valproate might significantly reduce nausea compared to sodium valproate alone. However, researchers indicated that combining the two treatments did not reduce the frequency of migraine attacks.
Donnelly says that using a Sea-Band wristband may be more accessible to some people.
Patel says cognitive behavioral therapy (CBT) is a mental health intervention that helps people notice thought and behavioral patterns and develop healthier coping skills.
Though commonly used to treat anxiety and depression, a 2022 systemic review and meta-analysis indicated that CBT can help reduce migraine frequency.
“CBT can help with triggers like stress,” Patel says. “If you are able to retrain your brain and calm down the sympathetic nervous system, you can prevent it from spiraling.”
This could potentially reduce migraine and migraine symptoms.
Hands-on treatments like massage or craniosacral therapy might help reduce nausea and other migraine symptoms.
A small 2017 study of 48 females between the ages of 33 and 58 indicated that feet reflexology and segmental massage were safe alternatives to pharmacological interventions in people with migraine.
Segmental massage is a form of massage therapy that’s said to influence the interaction of the muscles with the skin and inner organs.
A 2022 RCT indicated that craniosacral therapy might reduce pain and frequency of migraine episodes.
Migraine affects a billion people worldwide annually.
“For some, the nausea is worse than the pain,” says Cohen.
According to a 2022 study, up to half of the people with episodic migraine experience nausea in more than half of their migraine episodes. The attacks also included more headache symptoms and a higher impact, compared to those with less frequency of nausea.
In a 2020 study of more than 6,000 participants, about 28% reported that migraine-related nausea was their most bothersome symptom.
“For those [people], it really should be treated,” says Donnelly.
But Cohen says people with migraine often don’t bring up nausea unless asked. There are several remedies available to treat nausea associated with migraine attacks, whether it’s your “most bothersome symptom” or your least.
Cohen quips that if anyone could officially answer this question, they’d win a Nobel Prize. In short, experts don’t know for sure.
The 2022 study above notes that those who experience nausea and cyclic vomiting syndrome have decreased connectivity between the sensorimotor network and the insula, an area linked with self-awareness, perception of sensation, and pain processing. There may also be a relationship with dopamine.
“The same neuropeptides … that cause head pain during a migraine attack also go and work on nerve endings in the GI system and cause gastroparesis, slowing down of the GI system,” says Niaz. “This leads to nausea and delayed gastric absorption and emptying.”
Gastroparesis is also a reason why oral migraine medications don’t help everyone.
“Their GI tract is slowed down, and the medication is not being absorbed,” Niaz says.
A 2018 research review suggested that migraine triggers like stress might affect the central nervous system, or CNS, which is responsible for controlling involuntary functions, including digestion. Migraine-related nausea might suggest a change in digestion.
While the mechanics of what triggers nausea during a migraine is unclear, the American Migraine Foundation and experts share that it can occur during the prodrome phase before the attack or at the headache stage.
“There is no headache that doesn’t potentially have nausea as a symptom,” says Patel.
Any migraine can come with nausea — hemiplegic, menstrual, vertigo, and vestibular migraine included. Patel says people prone to migraine attacks with or without aura can also experience nausea symptoms.
Research from 2016 indicated that motion-induced dizziness with nausea was the most common symptom in people with vestibular migraine attacks.
A small 2020 cross-sectional study of more than 120 women ages 12–55 indicated that participants who experienced menstrual migraine attacks experienced more nausea than participants with other types of primary headaches.
“Since nausea is second to the migraine, you want to prevent the migraine,” Donnelly says.
Every expert echoed Donnelly’s response to this question. The basics apply here. Lifestyle tweaks that can help prevent migraine attacks include:
Additionally, doctors can prescribe preventive medications to reduce migraine frequency.
Get the facts about migraine and nausea below.
Nausea can be a sign of a migraine episode if it’s associated with a headache. Additionally, nausea may appear during the prodromal phase of a migraine, which can present hours to a few days before a headache.
It varies. Nausea can last for 48 hours before a headache presents, which is what providers call the prodromal phase. It can also last through the headache and up to about 24 hours.
Every person will find their own “normal.” You should seek medical care if you’re also feeling dehydrated, listless, or experiencing nausea that’s worse than your baseline or more progressive. Additionally, you should seek care if you’re experiencing intractable (out of control) vomiting.
You might consider using OTC remedies like Dramamine or Benadryl for migraine nausea. Additionally, prescription medications like Zofran and Reglan are available. Zofran is often prescribed first due to fewer side effects.
Eat whatever you can tolerate during migraine nausea. Try bland foods like toast, bananas, and applesauce.
Nausea is a common migraine symptom, and for some, it’s the most bothersome.
It’s unclear what precisely causes migraine-related nausea, but it’s thought that it affects the same nerve endings that trigger migraine, slowing digestion and leading to nausea.
There are several lifestyle tweaks, home remedies, and OTC medications that can help.
Medically reviewed on March 07, 2024
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