Why You Puke (or Want to Puke) During a Migraine

Nausea is one of the most common symptoms of a migraine attack. Nausea and vomiting can occur before, during, or after a migraine headache. Anti-nausea medications and alternative treatments can help.

Nausea is a common symptom of migraine. It can happen before, during, or after the onset of a migraine attack.

Although nausea is common, people experience migraine differently. Nausea can occur at any point, and it may or may not lead to vomiting. Nausea can occur in people with different types of migraine, including migraine with aura and without aura.

Many alternative treatments and prescription medications can help with migraine-related nausea.

Many people experience nausea before or during a migraine attack.

In a 2019 study involving 6,045 people with migraine, about 65% reported experiencing nausea, light sensitivity, and sound sensitivity during migraine episodes. Around 28% said nausea was their most bothersome migraine symptom.

The American Migraine Foundation says nausea may occur during two stages of an attack: prodrome and headache. Prodrome is the period before a migraine headache that can last from a few hours to a few days. The headache stage can last from 4 to 72 hours. Some people experience aura between the prodrome and headache stages.

Some people may experience nausea in all stages of a migraine episode. A 2012 study found that 51% of 861 migraine attacks studied included nausea as part of the aura phase.

Researchers don’t know what causes migraine or nausea associated with migraine.

One idea, outlined in a 2018 research review , is that migraine triggers, such as stress, activate the central nervous system (CNS) pathways.

The CNS handles the body’s autonomic (involuntary) functions, such as heart rate and digestion. Nausea and vomiting indicate a change in the autonomic system function.

Some people with migraine have gastroparesis, a condition in which there is a delay in emptying the stomach contents. Nausea and vomiting are common symptoms of gastroparesis.

You can get nausea with any type of migraine.

The International Classification of Headache Disorders (ICHD-3) includes nausea as part of the diagnostic criteria for migraine without aura. It does not include nausea in the criteria of migraine with aura.

According to ICHD-3, someone must have nausea and vomiting or light and sound sensitivity during a headache to receive a migraine without aura diagnosis.

Nonetheless, many people who experience aura can have nausea during some or all attacks.

If you experience nausea during a migraine attack, you can take steps to feel better. You can get prescription medications from your doctor or use alternative or home therapies.

Antiemetics

Antiemetics are medications to treat nausea and vomiting. A doctor may prescribe an antiemetic and another drug for you to take during a migraine attack.

The American Academy of Family Physicians lists five antiemetics that may be appropriate as treatments for nausea associated with acute migraine:

• chlorpromazine
• droperidol
• metoclopramide
• prochlorperazine
• promethazine

These medications are available in different formulations, like nasal spray, sublingual tablet, or liquid, that may help you keep them down during episodes of nausea and vomiting.

Acupressure

Acupressure is a technique involving a professional applying pressure to specific points on the body. Unlike acupuncture, acupressure doesn’t use needles. Acupressure may help with nausea associated with migraine.

Ginger

Ginger is a common remedy for nausea. There is also evidence it helps with migraine-associated nausea and may help with other migraine symptoms.

A small 2020 review that included three studies found ginger helped people with migraine to reduce pain within 2 hours. Study groups that took ginger had less vomiting and nausea than the control groups.

Aromatherapy

Aromatherapy is an alternative treatment that uses scents from plant extracts to enhance well-being. There is some evidence that peppermint essential oil may help with nausea.

A small 2020 study involving 80 people receiving chemotherapy for cancer found peppermint oil may help reduce nausea and vomiting.

Thirty-six of the 80 people placed a drop of peppermint oil on their upper lips three times a day for 5 days in addition to taking antiemetic drugs. They experienced less frequent nausea and vomiting than those who took the antiemetics alone.

You may be able to prevent migraine-induced nausea by taking steps to reduce the frequency of migraine attacks.

• Lifestyle changes: These changes can involve following the SEEDS mnemonic, getting quality sleep, eating balanced meals at regular intervals, exercising regularly, keeping a headache diary, and managing stress, which all may help prevent or reduce migraine attacks.
• Avoiding triggers: After tracking your migraine attacks, you may get a better picture of your triggers. Avoiding them can help prevent or decrease migraine.
• Medications: Preventive migraine treatments available by prescription include beta-blockers, antidepressants, antiseizure medications, calcium channel blockers, and calcitonin gene-related peptide antagonists.
• Alternative treatments: Practices like yoga, relaxation training, biofeedback, and cognitive behavioral therapy may help reduce the number of attacks or prevent them.

If nausea occurs late in your migraine attacks, you may want to try to take acute treatment medications early in the attack so you do not vomit the medication.