Migraine and nausea
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Prevalence and Impact of Nausea in Migraine
Nausea is one of the most common and disabling symptoms experienced during migraine attacks, affecting over 90% of migraine sufferers according to large-scale surveys and clinical studies 2346. In both adults and children, nausea frequently accompanies migraine episodes, with a significant portion of patients also experiencing vomiting 26. Nausea is often reported as the most bothersome symptom, even more so than photophobia or phonophobia, and is a key factor in the overall burden of migraine 78.
Nausea as a Premonitory and Central Symptom in Migraine
Research shows that nausea can occur as a premonitory symptom, appearing before the onset of headache pain in about a quarter of patients 13. Brain imaging studies have identified activation in specific brain regions, such as the rostral dorsal medulla and periaqueductal grey, during the premonitory phase in patients experiencing nausea. These areas are known to be involved in the central regulation of nausea, indicating that migraine-related nausea is not solely a response to pain but is a centrally driven symptom 110.
Clinical Significance and Burden of Migraine-Associated Nausea
The presence and intensity of nausea during migraine attacks are linked to a higher frequency and severity of migraine episodes, increased risk of pain recurrence, and greater social disability 347. Persistent and frequent nausea is also associated with progression from episodic to chronic migraine, highlighting its role in worsening the disease course . In children and adolescents, early onset of migraine is often associated with more severe nausea and vomiting, and the intensity of headache correlates directly with the intensity of nausea .
Nausea and Migraine Treatment Challenges
Nausea and vomiting can significantly interfere with the ability to take oral migraine medications, with up to 42% of patients reporting difficulty during attacks . This makes effective management of nausea crucial for successful migraine treatment. Patients often prioritize medications that do not cause or worsen nausea and that provide rapid relief from both headache and associated symptoms 28.
Therapeutic Approaches for Migraine-Associated Nausea
Non-pharmacological interventions, such as acupressure at the PC6 (Neiguan) acupoint, have shown promise in reducing the intensity of nausea during migraine attacks . This approach can be particularly helpful for patients who struggle to take oral medications due to severe nausea. Individualized treatment strategies that address both headache and associated symptoms like nausea are recommended for improving quality of life in migraine patients .
Conclusion
Nausea is a highly prevalent, centrally mediated, and often the most bothersome symptom in migraine, significantly impacting patients’ quality of life and complicating treatment. Recognizing and effectively managing nausea is essential for comprehensive migraine care, especially given its association with more severe disease and progression to chronic migraine 12346789+1 MORE.
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