What Should I Do If I Throw Up My Medication?

Many people with migraine experience nausea, and some will vomit during an attack. Vomiting, especially if it occurs early in the migraine attack, can prevent medication absorption, reducing effectiveness. In this article, we explore several strategies to manage this issue effectively.

Strategies for Managing Nausea & Vomiting during Migraine Attacks

1. Treat early: If you vomit after you have had the attack for some time, taking your medication early in the attack before the nauseous stage gives it time to be absorbed.

    

2. Add an anti-nauseant: You can take a medication to reduce your nausea and prevent vomiting early in your attack with your migraine medication. A good anti-nauseant or anti-emetic is:
   1. Metoclopramide tablet (10 mg dose)
   2. Domperidone (10 mg dose)
   3. Prochlorperazine (Stemetil), taken as a 10 mg tablet. Prochlorperazine may have more side effects than the first two medications mentioned. Prochlorperazine can also be taken as a suppository (one or two 10 mg suppositories). The suppository allows for the medication to be absorbed if you are vomiting.  

*Dimenhydrinate (Gravol) may be helpful, but it is usually less effective than the medications mentioned above.

3. Try a triptan wafer: If swallowing a triptan tablet and water worsens your nausea, consider a triptan wafer (Maxalt or Zomig). These orally dissolving tablets melt in your mouth and do not require water. Maxalt tastes like mint, and Zomig tastes like orange. Some people have difficulty with these flavours.

    

4. Try a nasal spray: Consider triptan nasal sprays, such as zolmitriptan (Zomig) nasal spray (5 mg spray), and the sumatriptan (Imitrex) nasal spray (20 mg spray). These sprays, especially the zolmitriptan nasal spray, are absorbed partly through the nose, and therefore can be helpful even if you have a lot of nausea.

    

5. Consider injectors: If vomiting occurs quite early in your migraine attack (for example if you wake up and the migraine attack is fully developed), consider the sumatriptan (Imitrex) injection (6 mg dose).  It is easy to inject yourself with this medication (speak to your doctor or pharmacist about how to do this), and it will be in your body to relieve your migraine no matter how much you vomit. Another injectable option is dihydroergotamine (DHE), but as the syringe needs to be prepared by the person, it is more complicated to use.

6. Use rapid-absorption NSAIDs: For those taking non-steroidal anti-inflammatory medications, taking a medication with fast absorption into the body may be helpful so that the absorption occurs before you vomit. There are two medications which are designed for fast absorption:
   1. Liquid ibuprofen tablet (Advil liquid gel)
   2. Diclofenac powder (Cambia). The powder is dissolved in water before you take it, so it is absorbed very quickly

      You can take an anti-nauseant medication with your non-steroidal anti-inflammatory medication if necessary.  Indomethacin and naproxen exist as suppositories. Suppositories are absorbed in the veins of the rectum and are fast-acting.

Consult your doctor to determine the best treatment for you. If frequent migraine attacks persist despite the above measures, consider daily preventive medication and lifestyle changes to reduce migraine frequency and severity.