Nausea Migraine

Many times the onset of a migraine means nausea migraine and vomiting go hand in hand. When the headaches are severe, you might progress to full vomiting. Somehow, with some people, this relieves the headache a bit and at the present time we are not quite sure why this happens.
Most times, in adults, the condition is treated with small doses of anti-nausea drugs. Low level nausea often responds well to ginger tea.

Did you know that these medications treat the headache too? Most people are unaware of this so if nauseated, this medication combined with your other abortive medications, could treat the symptoms of nausea migraine much faster.

Many people know that ginger tea may also help with low level nausea, but if severe with vomiting you may need a prescription. The cause of the nausea is actually coming from that area of the brain responsible for migraine. These headaches are ruled by a subset of serotonin receptors known as the 5-HD receptors. Unfortunately, another subset of serotinin receptors controls nausea and vomiting which is why migraines are associated with these symptoms.

Treatments For Nausea Migraine

For severe symptoms, medications are available. These will treat the nausea and vomiting and will also calm the headache by dampening the dopamine pathways in the brain. These are the pathways responsible for registering pain. Each of the following can be used:

  • Compazine (prochlorperazine)
  • Reglan (metoclopramide)
  • Zofran (ondansteron)

These can work quite well and compazine in particular is available in rectal suppositories. I do prescribe these for severe vomiting, but generally speaking, most people can get away with the pill form.

Alternative therapies such as ginger tea or ginger ale (yes made with real ginger!) may help as do some over the counter medications such as Pepto Bismol.

Side Effects

Generally speaking, the main side effect of these drugs for treatment of nausea migraine, is sedation. At times that may work in your favor if you have a severe migraine. Sleep can relieve pain and at this time we are not quite sure how this happens. I will tell my patients, that if they have to function and go to work, to take 1/2 of the standard dose prescribed.

Additional side effects include lightheadedness, and they may provoke anxiety or panic if you already have anxiety. Zofran has less tendancy to do this. These are the main side effects if doses are take only a few times a month.

Many times, Reglan is prescribed by GI physicians to treat chronic heartburn and other issues. This can be problematic if you start to have stiffining of the muscles, and tremors. Rarely, these drugs can cause parkinsonism (symptoms of Parkinsons without the disease) and unfortunately, many times this is permanent. Reversing the drug does not always stop the problem.

The main side effects of Pepto Bismol are darkening of the stools and constipation as it is also used to treat diarrhea.

But what about children? In children, this type of nausea and vomiting can be disabling and take them out of school.

Cyclic Vomiting in Children with Headaches

There is a condition that occurs in children with headache that is known as "cyclic vomiting syndrome". CVS is characterized by explosive vomiting in a child and may be recurrent with no apparent underlying cause.

It begins sometimes in pre-school or elementary school and the child may vomit may times an hour with the frequency slowing over hours or even days. They may have a headache, look pale and even have diarrhea.

The cause of cyclic vomiting? More often than not..stress! Any type of stress: tests, divorce, homework, birthday parties, viruses, you name it.

Many times there is a family history of migraine.

Treatment of Vomiting in Children

This condition should be co-ordinated between a neurologist and a gastroenterologist. Once GI issues causing the vomiting have been ruled out, the whole condition must be treated.

If the sickeness is acute, then anti-nausea medication and perhaps IV hydration might be needed. More often than not, this condition comes under control with the treatment of the stress.

Try not to get upset about the condition..it is more common than you think and many times missed by physicians and practitioners. Treatment of the stress means learning coping skills which we all have to learn as we grow up.

As always, speak to your pediatrician first and get some advice as to how to handle this. The pediatrician may start you off by sending the child to a gastroenterologist and if that work up is normal, by all means consider a neurologist. The nausea migraine connection may be stronger than you think.

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