white capsules on a pink background reglan for migraine
Medication,  Migraine,  Nausea

How To Take Control Of Nausea During A Migraine Attack

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Guest Post By Thomas Berk, M.D., Medical Director, Neura Health

One of the salient features of migraine – what distinguishes migraine from other headache disorders – is the presence of nausea. You don’t have to experience nausea in order for your headache to be considered migraine, but most people do experience it as part of their migraine attacks. The nausea does not actually come from the gut, but it is due to activation of certain areas of the brain by inflammatory neurotransmitters. Many anti-nausea medications can treat migraine as well, and could be a helpful addition to your acute migraine treatment plan. 

Reglan for migraine

Reglan (metoclopramide) is the medication that has the best evidence for treatment of migraine in an emergency room setting. Reglan for migraine attacks is typically given intravenously in an emergency room, but it can be given orally to be taken at home as well.  An uncommon reaction some people experience with Reglan is called akathisia – an “ants in the pants” feeling, like you just have to keep moving.  Benadryl (diphenhydramine) is an effective antidote for akathisia, but if you do experience this, you should use a different medication. 

** While the guest writer is a doctor, this article is for informational purposes only and not a substitute for individual medical advice from your own doctor.

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Compazine for migraine

Compazine (prochlorperazine) is similar to Reglan, but significantly more sedating.  It can also be more potent, and is available as intravenous, oral and as a suppository.  It can also be associated with akathisia, and should be avoided if you experience akathisia with Reglan.  It would be the next stronger medication if Reglan is not effective enough, or if you can’t sleep due to the pain of migraine. Compazine for migraine is also commonly used to to break a stubborn migraine. 

Phenergan for migraine

Phenergan (promethazine) is the least sedating of these anti-nausea medications. It typically is the most gentle and for this reason can also be less potent.  There are multiple doses of Phenergan, and it is also available in intravenous, oral and suppository forms. It is much less likely to lead to akathisia, and can be tried if you previously experienced akathisia with either of the other anti-nausea medications. Phenergan for migraine relief is often effective and commonly prescribed by headache specialists.

Haldol (haloperidol) and Thorazine (chlorpromazine) for migraine

These medications are in the same family as Reglan, Compazine and Phenergan, but are less commonly used for nausea, although they can be very effective anti-nausea medications in their own right.  They are much more sedating, and overall more potent.  Haldol is more likely to be associated with akathisia, but these two medications are often avoided due to their excessive sedations.  

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Zofran for migraine

Zofran (ondansetron) is in a different class than all of those other anti-nausea medications, and for this reason it treats the nausea better than the headache pain.  It also can be added on to other acute migraine treatments, and can even be added in addition to one of the other anti-nausea medications. Zofran for migraine is widely known by headache specialists but less known by general practitioners. It is not associated with either sedation or akathisia, and can be used if you previously experienced akathisia with another medication. 

Conclusion

Anti-nausea medications are effective acute treatments for migraine. They are frequently added to other medications when nausea is particularly severe during a migraine attack, but they can even be used as stand-alone treatments. One particular use is to help avoid “rebound” or medication overuse headache, which can occur if an individual migraine medication is used very frequently over a period of time. As a class, the anti-nausea medications have not been associated with medication overuse headache, and are often a good option to consider when this does occur.

About the Author

Dr. Thomas Berk is a neurologist and headache specialist in New York City, and the Medical Director of Neura Health. He has over 11 years of clinical experience, having graduated from the NYU Grossman School of Medicine in 2010. He completed his neurology residency at NYU as well and is a board-certified headache specialist, having completed a headache fellowship at the Jefferson Headache Center. He is an emerging leader of the American Headache Society and has been on the Super-Doctor’s list of rising stars for the past three years.

Note from the Migraine Strong writers – Dr. Berk provided excellent information on prescribed medications to discuss with your doctor. For additional resources on migraine nausea remedies, you may find these articles interesting:

Migraine Nausea: 15 Tips to Help You Find Relief

The Gist About Ginger For Migraine Treatment

Allay Lamp: Green Light Therapy for Vestibular Migraine

Benadryl for Migraine – 19 Important Questions and Answers You Need to Know

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How To Take Control Of Nausea During A Migraine Attack

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