Migraine and nausea
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Migraine and Nausea: Understanding the Connection and Management
Introduction to Migraine-Associated Nausea
Migraine is a complex neurological disorder characterized by recurrent headaches and a variety of associated symptoms, including nausea. Nausea is a prevalent and debilitating symptom that significantly impacts the quality of life of migraine sufferers4 7. Understanding the mechanisms behind migraine-associated nausea and exploring effective management strategies is crucial for improving patient outcomes.
Pathophysiology of Nausea in Migraine
Central Mechanisms
Research indicates that nausea in migraine is centrally driven, involving specific brain structures. A PET study revealed that activation in the rostral dorsal medulla and periaqueductal grey (PAG) is associated with nausea during the premonitory phase of a migraine attack, independent of pain and trigeminal activation2. These brain regions include the nucleus tractus solitarius, dorsal motor nucleus of the vagus nerve, and the nucleus ambiguus, which are integral to the brain circuits mediating nausea2.
Peripheral and Central Interactions
The interaction between central and peripheral processes also plays a role in the manifestation of nausea during migraine. The trigeminovascular pathway, which is activated during migraine attacks, contributes to the headache and associated symptoms, including nausea7 10. This pathway's involvement underscores the complexity of migraine pathophysiology, where multiple neuronal systems function abnormally7.
Prevalence and Impact of Nausea in Migraine
Nausea is a common symptom among migraine sufferers, with studies showing that it affects over 90% of individuals with migraine4. The American Migraine Prevalence and Prevention (AMPP) Study highlighted that persistent frequent nausea (PFN) is a significant predictor of progression from episodic migraine (EM) to chronic migraine (CM)5. This finding emphasizes the importance of addressing nausea in migraine management to prevent the worsening of the condition.
Management Strategies for Migraine-Associated Nausea
Acupressure
One promising approach to managing migraine-associated nausea is the use of acupressure. A study investigating the efficacy of the Sea-Band® wristband, which applies continual pressure to the PC6 acupoint, found significant reductions in nausea intensity during migraine attacks1. Patients reported a 50% reduction in nausea scores at various time points, demonstrating the potential of acupressure as a non-pharmacological intervention1.
Pharmacological Treatments
Pharmacological treatments for migraine often include antiemetic medications to address nausea and vomiting. Amitriptyline, a tricyclic antidepressant, has shown effectiveness in controlling nausea in patients with migraine, particularly in those with a history of cyclical vomiting syndrome6. The choice of medication should be individualized based on the patient's specific symptoms and response to treatment10.
Conclusion
Nausea is a prevalent and debilitating symptom of migraine that significantly impacts patients' quality of life. Understanding the central and peripheral mechanisms underlying migraine-associated nausea is essential for developing effective management strategies. Both non-pharmacological approaches, such as acupressure, and pharmacological treatments, including antiemetics and prophylactic medications, play a crucial role in alleviating nausea and improving patient outcomes. Addressing nausea in migraine management is vital to prevent the progression to chronic migraine and enhance the overall quality of life for sufferers.
Sources and full results
Most relevant research papers on this topic
Acupressure in the control of migraine-associated nausea
Acupressure at the PC6 acupoint effectively reduces migraine-associated nausea, with consistent results achieved in 28-59% of patients.
RCTThe origin of nausea in migraine–A PET study
Nausea in migraine is a centrally driven symptom, occurring as a premonitory symptom independent of pain and trigeminal activation.
Observational Study
Very Rigorous Journal
Highly CitedFrequency and Burden of Headache‐Related Nausea: Results From the American Migraine Prevalence and Prevention (AMPP) Study
While nausea is a defining feature of migraine, the association of nausea with other headache features and its influence on the burden of migraine have not been quantified. Population‐based data were used to elucidate the relative frequency and burden of migraine‐associated nausea in persons with migraine.
Observational StudyHighly CitedMigraine Symptoms: Results of a Survey of Self‐Reported Migraineurs
Migraine sufferers report pain, nausea, vision problems, and vomiting as the most common symptoms, with nausea and vomiting often hindering their ability to take migraine medication.
Observational StudyHighly CitedPersistent Frequent Nausea Is Associated With Progression to Chronic Migraine: AMPP Study Results
Persistent frequent nausea in individuals with episodic migraine is a significant predictor of the progression to chronic migraine.
Rigorous JournalMigraine as a cause of persistent nausea or vomiting in palliative care: a case series.
Migraine can cause persistent nausea and vomiting in palliative care patients, and amitriptyline may be particularly useful in treating these symptoms.
Case ReportMigraine: Multiple Processes, Complex Pathophysiology
Migraine is a complex, multifactorial headache disorder involving multiple neuronal systems and structural and functional abnormalities in the migraine brain, leading to extreme sensitivity to fluctuations in homeostasis and recurrence.
Very Rigorous JournalHighly CitedMost Bothersome Symptom in Persons With Migraine: Results From the Migraine in America Symptoms and Treatment (MAST) Study
Nausea, phonophobia, and photophobia are the most bothersome symptoms in individuals with migraine, with phonophobia being the most common and photophobia being the least common.
Observational StudyVery Rigorous JournalHighly Cited