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Why Migraine Causes Nausea

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As someone living with migraine, you’re likely familiar with the unwelcome wave of nausea that often accompanies the head pain. This isn’t a simple case of cause and effect; it’s a complex biological cascade triggered during a migraine episode.

Role of Neurotransmitters in Migraine Nausea

Neurotransmitters are the chemical messengers in your brain and body. They play a significant role in both migraine and the resulting nausea.

Serotonin, a key neurotransmitter, is often called the “feel-good” chemical because of its role in mood regulation. But it’s also intricately involved in both migraine and gut function.

During a migraine attack, serotonin levels fluctuate. This fluctuation is a critical factor in migraine pathophysiology, and because serotonin receptors are found throughout the gut, these fluctuations can directly impact gastrointestinal function. When serotonin floods the system, it constricts and dilates blood vessels, a process associated with the onset of migraine pain. In the gut, it affects the movement of your intestines, often leading to slower gastric emptying — a condition called gastroparesis. This slowing down can make you feel full, bloated, and nauseous.

Another neurotransmitter, substance P, is also involved. It’s related to pain perception and transmitting pain signals to the brain. During a migraine, if substance P levels increase in the body, they can cause inflammation and pain, and when released in the gut, they can contribute to nausea and vomiting.

The Gut-Brain Axis and Migraine Nausea

The gut-brain axis is the network of nerves linking the central nervous system to the enteric nervous system (which manages the gastrointestinal tract). This axis is a two-way street, with messages transmitted from the brain to the gut and from the gut to the brain.

In the context of a migraine attack, this communication can go awry. The brain’s heightened sensitivity to pain and disruption caused by a migraine attack can send signals to the gut that disrupt its normal functioning, contributing to symptoms like nausea and vomiting. Conversely, irritation in the gastrointestinal system can send signals back to the brain that can worsen migraine symptoms, creating a feedback loop that exacerbates both head pain and stomach distress.

Inflammation is another key aspect of the gut-brain axis that can contribute to nausea. During a migraine attack, inflammatory molecules can be released and can impact gut function, leading to the nausea so many people with migraine experience.

Triggers and Aggravators of Nausea in Migraine Episodes

Understanding your sensory triggers can be a critical step in managing your symptoms.

Sensory Stimuli and Migraine Nausea

Your heightened sensitivity during a migraine episode can turn ordinary sensory inputs into overwhelming stimuli. Bright lights, strong smells, or loud sounds are triggers that can initiate a cascade of biological responses leading to or intensifying nausea.

  • Bright lights: Photophobia, or light sensitivity, isn’t just about discomfort. It can activate neural pathways that aggravate migraine pain and nausea.
  • Strong smells: Olfactory hypersensitivity means that odors—pleasant or otherwise—can increase the likelihood of nausea during a migraine.
  • Loud sounds: Phonophobia is not uncommon in migraine, and the auditory overload can be closely linked to the development of nausea.

Dietary Factors Contributing to Migraine Nausea

Your diet can influence your migraine experience, especially when it comes to nausea. Certain foods are known to be potential migraine triggers, and they can also be culprits in heightening your sense of nausea.

  • Caffeine: Both excess caffeine and caffeine withdrawal can be problematic. This stimulant can cause your vessels to constrict and then dilate, contributing to both migraine pain and nausea.
  • Alcohol: Red wine and other histamine-containing drinks can trigger migraine episodes and subsequent nausea in many individuals.
  • Processed foods: These often contain additives like MSG, nitrates, or artificial sweeteners that may trigger migraine and related nausea.
  • Irregular meals: Skipping meals or fasting can lead to drops in blood sugar, which can trigger a migraine attack and make nausea worse.

It’s not just about eliminating certain foods; it’s about understanding how your diet interacts with your migraine episodes.

Diagnosing Migraine-Related Nausea

The diagnosis begins with your detailed account of symptoms, including intensity, frequency, and duration, of your nausea so that they can eliminate other underlying causes.

  • Medical history: Your doctor will consider your overall medical history, including any family history of migraine.
  • Symptom tracking: Keeping a log of your migraine and associated symptoms like nausea can help establish patterns and triggers.
  • Physical examination: A comprehensive physical exam can rule out other potential causes of nausea.
  • Neurological examination: This can help determine if there are any other neurological causes for your symptoms.

Medications Used to Treat Migraine Nausea

Several medications can effectively manage nausea during migraine episodes:

  • Antiemetics: These drugs are specifically designed to alleviate nausea and can be taken alongside your migraine medications.
  • Triptans: While primarily used to treat migraine pain, some triptans can also help relieve nausea.
  • NSAIDs: Nonsteroidal anti-inflammatory drugs can lessen the inflammation that might contribute to both migraine pain and nausea.
  • Prescription medications: Certain prescription medications can address multiple migraine symptoms, including nausea.

Alternative Therapies for Managing Migraine Nausea

In addition to medications, several alternative therapies might offer relief:

  • Acupressure and acupuncture: These traditional Chinese medicine techniques can help regulate energy flow and alleviate nausea.
  • Aromatherapy: Certain scents like peppermint or ginger essential oils can relieve nausea for some.
  • Relaxation techniques: Stress-management strategies such as deep-breathing exercises, meditation, and biofeedback can help control the body’s response to migraine episodes and reduce nausea.
  • Dietary supplements: Some people find that supplements like ginger, vitamin B6, or magnesium can help manage nausea.

Coping Strategies for Migraine-Related Nausea

Managing migraine-related nausea requires a multifaceted approach tailored to your personal experiences. Here are some strategies:

  • Identify triggers: Recognize and avoid food or environmental triggers.
  • Eat regularly: Avoid long gaps between meals to prevent hypoglycemia-related nausea.
  • Balanced diet: Incorporate a diet low in processed foods and rich in fruits, vegetables, and whole grains.
  • Stay hydrated: Drink water throughout the day; dehydration can exacerbate migraine and nausea.
  • Adequate sleep: Prioritize sleep and maintain a consistent sleep schedule.
  • Rest in a dark, quiet space: Create a soothing environment to rest during migraine attacks.

Understanding the link between migraine and nausea equips you to manage this symptom more effectively. By being proactive in your care, you can lessen the impact of nausea and take control of your migraine episodes.

Getty image by damircudic

Originally published: November 13, 2023
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