Headaches, including migraines, affect millions of people. Unfortunately for some, migraine headaches can be accompanied by unpleasant symptoms such as nausea, adding to the challenge of this painful and often debilitating condition. Distinct from tension, sinus, and other types of headache, migraines are repetitive headaches that have specific accompanying symptoms, such as sensitivity to light or sound, changes in vision, nausea, and sometimes vomiting.
“There is a center in the brain which, if affected, can cause nausea and in some cases, vomiting,” says neurologist Mary Quiceno, MD, assistant professor at the University of Texas Southwestern Medical Center in Dallas. Neurologists specialize in treating migraines, among other conditions, and are familiar with the latest advances in medication and other therapies to get migraines under control.
Quiceno says nausea does not accompany a tension headache, so if you are nauseous and have a pounding headache, you are probably having a migraine. One survey of 500 people with frequent migraines found that more than 90 percent of them experienced nausea during an attack.
Treating Headache-Related Nausea
The good news is that headache nausea does respond to migraine treatment, says Dr. Quiceno. As a first step, you can try over-the-counter pain medications, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), and get rest. If that doesn’t work, there are a number of prescription medications that stop a migraine and its related symptoms.
When nausea and vomiting are problematic, your doctor may recommend a medication to control these symptoms specifically. These drugs are called anti-emetics or anti-nausea medications. However, these are not first-line treatments for headaches or even migraines with nausea, and are often reserved for patients who experience significant nausea or vomiting.
For patients who do use them,“research shows that anti-emetics can take care of both the headache and nausea,” says Quiceno. This is true for prochlorperazine (Compazine) and promethazine hydrochloride (Phenergan). In fact, some research has shown that anti-emetics may be more effective treatments for acute migraines than narcotic pain relievers. Other anti-emetics include chlorpromazine (Thorazine), trimethobenzamide hydrochloride (Tigan), and metoclopramide hydrocholoride (Reglan)
Anti-emetics do have side effects that include sleepiness and, for some people, tremors, so doctors prefer to try other remedies first.
When to Worry About Headache Nausea and Vomiting
You’re probably familiar with your headache pain pattern. Any time your headaches or migraines and related symptoms take on a new pattern, pay attention. “If there is a sudden increase in vomiting, that is a warning sign that something else may be going on,” says Quiceno. Contact your primary care doctor or neurologist for an evaluation.
You don’t have to live with pounding headaches or migraines and nausea. These symptoms can be managed with the help of your doctor and targeted medications.
Last Updated: 2/21/2012