Many migraine patients will have nausea with at least some of their attacks, and some will vomit.  Vomiting, especially if it occurs early in the migraine attack, can be a problem because if the patient throws up their medication before it is absorbed into the body, it obviously will not work well.  There are several things you can do to treat your headaches more effectively if this is what happens to you.

Treat as early as possible:

If you throw up only after you have had the attack for some time, you may still be able to take pills to treat your attack if you take them early in the attack so that they have time to get absorbed.

Add an anti-nauseant

You can take a medication to reduce your nausea and prevent vomiting early in your attack with your migraine medication.  Here are some options to discuss with your health care provider:

Dimenhydrinate (Gravol): Usual dose 50 mg. An over-the-counter option. May cause somnolence (which is sometimes welcome).  

Metoclopramide (Maxeran):  Usual dose is 10 mg.  

Domperidone: Usual dose of 10 mg. It is not an anti-nausea, but it promotes the natural movements of the stomach and may help the symptoms. 

Prochlorperazine (Stemetil): Usual dose 10 mg. It can be helpful although it may have more side effects than the medications mentioned above, including lowering the blood pressure.  

Odansetron (Zofran): 4 to 8 mg can be used. It exists in a dissolving film. Zofran is costly but very effective and usually well tolerated.

Wafers and dissolving forms 

  1. Zomig and Maxalt exist in this form that melts with very little saliva. You do not need to take water with them. Maxalt tastes like mint, and Zomig like orange. Some people have difficulty with those flavors.
  2. Cambia is a diclofenac powder that is mixed with water. It tastes like mint and aniseed (some hate it, some like it).

Nasal sprays 

  1. Zomig and Imitrex come in nasal sprays. These sprays are absorbed partly through the nose blood vessels. Sone of it is swallowed.They do not taste very good though. 
  2. DHE (Migranal) exists in nasal spray With regular use it may cause a drying of the nasal mucosa.

Suppositories

Even if this is not a very popular way of taking a medication, it has advantages. The suppository inserted in the rectum will dissolve and be picked up by the veins, so it can be effective when the gut is on hold. NSAIDs and anti-nausea drugs are available in this form. Discuss with your physician or pharmacist!

Injections can be helpful but are not commonly used and you may need a specialist to prescribe them. 

  1. Sumatriptan/Imitrex 6 mg comes in an auto-injector and is easy to use (speak to your doctor or pharmacist for instructions). Injectable sumatriptan acts very fast. It can cause particular side effects like jaw tightness and chest pressure, but these are not dangerous. 
  2. Dihydroergotamine (DHE) 1 mg, exists in an injectable form, but the syringe has to be prepared and it takes training to be comfortable with this.
  3. Ketorolac (Toradol) 30 mg is available, but you have to prepare the syringe It should be injected in the muscle and that takes some experience.

You can take one of the anti-nauseant medications with your non-steroidal anti-inflammatory medication or your triptan if necessary (see above).  

Speak to your doctor and decide which of these treatment options might be best for you.  Design a «special option» for attacks that are more severe. 

If your migraine attacks are frequent and taking acute medications for your migraine attacks as discussed above is not working very well, then you might want to consider a daily preventive (prophylactic) medication to make your attacks less frequent and less severe (See this post).  

If your attacks are very difficult to control, you may need to go to the Emergency Department. Read our page on this difficult situation (See this post). 

REFERENCES

Worthington I, Pringsheim T, Gawel MJ, Gladstone J, Cooper P, Dilli E, et al. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013;40(5 Suppl 3):S1-s80.

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