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Antiemetics for Migraine With Nausea

Medically Reviewed by Sabrina Felson, MD on February 20, 2022

If you deal with nausea and vomiting when you have a migraine, you’re not alone. Research suggests around 60% of people have these symptoms during some or all of their episodes.

Besides making you uncomfortable, nausea and throwing up lessen the effectiveness of medications taken by mouth to treat migraine. That’s where antiemetics -- drugs that ease nausea and vomiting -- come in. Taking them before or at the same time as your migraine treatments can help those medications stay down.

Prescription Medications for Nausea

Medications your doctor prescribes to help with nausea and vomiting in migraine are known as dopamine antagonists. Dopamine is a neurotransmitter -- a molecule that carries messages between nerve cells. Dopamine antagonists block the receptors that allow dopamine to work in the body. Options include:

Chlorpromazine (Thorazine). This drug is an antipsychotic. It keeps too much dopamine from building up in your brain. By blocking dopamine, chlorpromazine turns down the part of your brain that triggers vomiting. You can take chlorpromazine by mouth as a tablet or extended release capsule. You can also take it as a suppository. Or you might get it as a shot or IV infusion if you end up in the ER because of your symptoms. Possible side effects include but are not limited to:

  • Drowsiness
  • Dizziness
  • Weight gain
  • Vertigo (when you feel like your environment is spinning)
  • Dry mouth

Rarely, people who take it can form serious liver problems. If you have liver or heart issues, this choice may not be best for you.

Metoclopramide (Reglan). It blocks dopamine receptors in your gastrointestinal system instead of the brain. This helps your stomach digest better. It’s a tablet you take by mouth. You can also get it through an IV. You typically take metoclopramide just before or along with other medications for migraine.

It tends to cause fewer side effects than other antiemetics. You might have:

  • Restlessness
  • Drowsiness
  • Diarrhea
  • Muscle weakness

You shouldn’t take it if you have any kind of seizure disorder, GI bleeding, or a GI obstruction.

Prochlorperazine (Compro). Doctors sometimes prescribe this for migraines even if nausea and vomiting aren’t a symptom. It’s an antipsychotic and an antihistamine (which can help with vascular headaches). It blocks dopamine receptors in the brain.

You can take it by mouth as a pill, extended-release capsule, or liquid. You can also get it as a suppository, IV infusion, or shot in a muscle. Side effects can include muscle spasms, fewer periods, dizziness, skin reactions, blurry vision, and drowsiness. You may also have low blood pressure when taking it. You shouldn’t take it if you’re pregnant.

Over-the-Counter Medications for Nausea

The medications you’ll find in drugstores to treat nausea are typically motion sickness medications. They can also help you manage dizziness, another symptom of migraine. These include antihistamines such as:

You take all of these medications in pill form by mouth. Antihistamines lower your inner ear’s ability to sense motion. They also block messages to the part of the brain that controls nausea and vomiting. They work best if you take them early in your migraine.

Another treatment you can try for nausea is medication for stomach issues. These include:

Bismuth subsalicylate (Pepto-Bismol, Kaopectate). These medicines protect your stomach lining. Commonly, people use it to help treat nausea and vomiting from gastroenteritis (stomach flu), an upset stomach, or diarrhea.

Loperamide (Imodium). This medicine slows digestion in your bowels.

Alternative Treatments for Nausea

Along with other treatments for nausea, ask your doctor about adding the following options.

Ginger. Studies on pregnant women dealing with morning sickness and people with nausea from chemotherapy show that it is an effective and inexpensive treatment. Because it isn’t regulated by the FDA, doctors don’t have a standard recommendation for how often or how much to take.

There are very few side effects, although you could have heartburn, reflux, or excess gas.

It’s available in several forms including:

  • Ground in a capsule
  • Grated fresh in hot water to drink as a tea
  • In a sugar syrup base
  • Crystallized

Vitamin B6. Experts aren’t quite sure how vitamin B6 works to ease nausea. The vitamin helps process certain amino acids -- the building blocks of proteins -- which may help lessen the feeling.

You can get vitamin B6 naturally in foods such as:

  • Poultry
  • Fish
  • Potatoes
  • Chickpeas
  • Bananas
  • Fortified cereals

You can also take it in supplement form as a pill, capsule, or liquid. Some people experience side effects such as:

  • Headaches
  • Fatigue
  • Paresthesia, or the sensation of “pins and needles”

Show Sources

SOURCES:

Journal of Pain Research: “Humanistic and economic burden of nausea and vomiting among migraine sufferers.”

The Migraine Trust: “Acute medicines.”

National Library of Medicine: “Chlorpromazine,” “Prochlorperazine.”

American Family Physician: “Management of the Acute Migraine Headache,” “Nausea and Vomiting in Pregnancy.”

American Academy of Family Physicians: “Antiemetic Medicines: OTC Relief for Nausea and Vomiting.”

Integrative Medicine Insights: “The Effectiveness of Ginger in the Prevention of Nausea and Vomiting during Pregnancy and Chemotherapy.”

Mayo Clinic: “Vitamin B-6.”

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